Intracranial atherosclerosis: Review of imaging features and advances in diagnostics

Kim, Song; Schneider, David J.; Feldmann, Edward; Liebeskind, David S

doi:10.1177/17474930211066427

Cited by 12 publications

(15 citation statements)

References 63 publications

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“…In the current cohort, the risks of SIT within 1 year were similar in those with moderate and severe luminal stenosis in sICAS (7.5% vs 8.9%; p=0.688). Therefore, there have been advocates over a more comprehensive assessment of sICAS to gauge its ‘severity’ beyond the luminal stenosis alone 15 27…”

Section: Discussionmentioning

confidence: 99%

Risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamics

et al. 2022

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Background and purposeSymptomatic intracranial atherosclerotic stenosis (sICAS) is associated with a considerable risk of recurrent stroke despite contemporarily optimal medical treatment. Severity of luminal stenosis in sICAS and its haemodynamic significance quantified with computational fluid dynamics (CFD) models were associated with the risk of stroke recurrence. We aimed to develop and compare stroke risk prediction nomograms in sICAS, based on vascular risk factors and these metrics.MethodsPatients with 50%–99% sICAS confirmed in CT angiography (CTA) were enrolled. Conventional vascular risk factors were collected. Severity of luminal stenosis in sICAS was dichotomised as moderate (50%–69%) and severe (70%–99%). Translesional pressure ratio (PR) and wall shear stress ratio (WSSR) were quantified via CTA-based CFD modelling; the haemodynamic status of sICAS was classified as normal (normal PR&WSSR), intermediate (otherwise) and abnormal (abnormal PR&WSSR). All patients received guideline-recommended medical treatment. We developed and compared performance of nomograms composed of these variables and independent predictors identified in multivariate logistic regression, in predicting the primary outcome, recurrent ischaemic stroke in the same territory (SIT) within 1 year.ResultsAmong 245 sICAS patients, 20 (8.2%) had SIT. The D2H2A nomogram, incorporating diabetes, dyslipidaemia, haemodynamic status of sICAS, hypertension and age ≥50 years, showed good calibration (P for Hosmer-Lemeshow test=0.560) and discrimination (C-statistic 0.73, 95% CI 0.60 to 0.85). It also had better performance in risk reclassification and provided larger net benefits in decision curve analysis, compared with nomograms composed of conventional vascular risk factors only, and plus the severity of luminal stenosis in sICAS. Sensitivity analysis in patients with anterior-circulation sICAS showed similar results.ConclusionsThe D2H2A nomogram, incorporating conventional vascular risk factors and the haemodynamic significance of sICAS as assessed in CFD models, could be a useful tool to stratify sICAS patients for the risk of recurrent stroke under contemporarily optimal medical treatment.

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Section: Discussionmentioning

confidence: 99%

Risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamics

et al. 2022

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“…Asymptomatic CICAO patients have a high opening rate of collateral circulation, and those with collateral circulation opening tend to have mild clinical symptoms and a good prognosis when they are complicated by cerebral infarction. 7 The main etiology of occlusion is atherosclerosis, and inflammation contributes to atherogenesis, 8 as well as the formation of collateral circulation through multiple mechanisms. 9 An elevated lymphocyte count correlates with excellent collateral circulation, while a high WBC count and NLR level are associated with poor collateral circulation.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of the Neutrophil-to-Lymphocyte Ratio in Patients with Chronic Internal Carotid Artery Occlusion Complicated by Cerebral Infarction

Zhuo-yin¹,

Guo²,

Sheng³

et al. 2022

NDT

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Purpose This study aims to investigate the prognostic value of the peripheral neutrophil-to-lymphocyte ratio (NLR) in patients with chronic internal carotid artery occlusion (CICAO) complicated by cerebral infarction. Patients and Methods The clinical data of 99 CICAO patients complicated by cerebral infarction were retrospectively analyzed. The modified Rankin Scale (mRS) was used to assess their 3-month prognosis, and a multivariate logistic regression model was established to explore risk factors for poor prognosis. Results Multivariate logistic regression analysis demonstrated that NLR (OR=2.114; 95% CI: 1.129–3.959) and baseline National Institute of Health Stroke Scale (NIHSS; OR=1.288, 95% CI: 1.053–1.574) score were risk factors of poor prognosis. The area under the receiver operator characteristic (ROC) curve of NLR in predicting the 3-month outcome after onset was 0.717 (95% CI: 0.606–0.828, P <0.000). The optimal cut-off value was 3.22, with a sensitivity of 0.743 and a specificity of 0.791. Conclusion NLR is an independent risk factor for the poor prognosis of CICAO patients complicated by cerebral infarction and can serve as an indicator for clinical prognosis.

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“…In total, 1060 participants were included in the analysis (Figure 1). The median (IQR) interval from enrollment to HR-MRI scan was 17 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) months. Stroke-free participants without HR-MRI were older and less likely to be female.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…The prevalence of ICAS in stroke-free individuals ranges from 3.5% to 45% across different studies, probably due to differences in age, imaging techniques, and definitions [4,9,[11][12][13]. In addition, few studies have focused on non-stenosing ICAD; thus, its true prevalence is probably underestimated [14]. The rate of ICAD might exceed 80% in elderly people [11].…”

Section: Introductionmentioning

confidence: 99%

The prevalence and prognosis of asymptomatic intracranial atherosclerosis in a community‐based population: Results based on high‐resolution magnetic resonance imaging

Li,

Tang,

Zhang

et al. 2023

Euro J of Neurology

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Background and purposeIntracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke in China, but the prevalence and prognosis of asymptomatic ICAD detected using high‐resolution magnetic resonance imaging (HR‐MRI) is largely unknown. The aim of this study was to investigate the prevalence and prognosis in order to guide neurologists in interpreting ICAD detected on HR‐MRI.MethodsWe included stroke‐free participants from a community‐based prospective cohort (Shunyi study participants) who underwent HR‐MRI between July 2014 and April 2016. The participants were divided into two groups: those with or without ICAD (ICAD+ and ICAD−, respectively). ICAD included intracranial artery stenosis and non‐stenotic plaque. The primary outcome was ischemic stroke. Cox proportional hazard models were used to evaluate the association between ICAD and event outcomes.ResultsA total of 1060 stroke‐free participants evaluated by HR‐MRI were included from the Shunyi study. The median age at HR‐MRI was 56 years and 64.7% were female. The ICAD prevalence was 36.3% (n = 385). The ICAD+ group was older and had more cerebrovascular risk factors. The rates of ischemic stroke in the ICAD− and ICAD+ groups were 1.3% (n = 9) and 5.2% (n = 20), respectively, with a median follow‐up time of 54 months. ICAD was associated with an increased risk of ischemic stroke in the unadjusted and adjusted Cox models, with hazard ratios of 4.12 (95% confidence interval [CI] 1.87–9.05) and 2.50 (95% CI 1.05–5.94), respectively. The greatest risk of an event outcome was observed in participants with ≥70% stenosis or occlusion. The features of high‐risk plaques were also identified.ConclusionsWe found that ICAD detected using HR‐MRI increases the long‐term risk of a first‐ever ischemic stroke in a stroke‐free population, suggesting that the current primary prevention protocol of stroke awaits further optimization.

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Intracranial atherosclerosis: Review of imaging features and advances in diagnostics

Cited by 12 publications

References 63 publications

Risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamics

Risk stratification in symptomatic intracranial atherosclerotic disease with conventional vascular risk factors and cerebral haemodynamics

Prognostic Value of the Neutrophil-to-Lymphocyte Ratio in Patients with Chronic Internal Carotid Artery Occlusion Complicated by Cerebral Infarction

The prevalence and prognosis of asymptomatic intracranial atherosclerosis in a community‐based population: Results based on high‐resolution magnetic resonance imaging

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