A High-Resolution MRI Study of Relationship between Remodeling Patterns and Ischemic Stroke in Patients with Atherosclerotic Middle Cerebral Artery Stenosis

Abstract

Purpose: Recently, high-resolution magnetic resonance imaging (HR-MRI) has been used to depict the wall characteristics of the intracranial arteries. The aim of this study was to explain the relationship between the remodeling patterns and acute ischemic stroke in patients with atherosclerotic middle cerebral artery (MCA) stenosis using HR-MRI.Materials and Methods: From August 2015 to May 2016, we prospectively screened 33 consecutive patients with unilateral MCA stenosis using time-to-flight MR angiography, including 15 patients with symptomatic MCA stenosis and 18 patients with asymptomatic MCA stenosis. Among them, 14 patients were diagnosed as positive remodeling (PR) and 19 as negative remodeling or non-remodeling. The cross-sectional images of the stenotic MCA wall on HR-MRI including T1WI, T2WI, and PDWI were compared between the symptomatic group and the asymptomatic group as well as the PR group and the non-PR group, based on the vessel area, lumen area, wall area, plaque area, degree of stenosis, remodeling index, and NIHSS score.Results: The symptomatic group had larger wall area (P = 0.040), plaque area (P<0.001), degree of stenosis (P = 0.038), remodeling index (P < 0.001), and NIHSS score (P = 0.003) as well as smaller lumen area (P = 0.001) than the asymptomatic group. In addition, more PR patients were observed in symptomatic group. The PR group had larger plaque area (P = 0.014) and NIHSS score (P = 0.037) than the non-PR group. Demographic and clinical characteristics between the symptomatic group and the asymptomatic group, the PR group and the non-PR group showed no statistical difference.Conclusion: The current study suggests that the HR-MRI has emerged as a promising tool to detect the characteristics of intracranial arteries wall and reveal the relationship between remodeling patterns and ischemic stroke. The PR is an unsafe remodeling way and is prone to cause acute ischemic stroke.

Combination of Plaque Characteristics, Pial Collaterals, and Hypertension Contributes to Misery Perfusion in Patients With Symptomatic Middle Cerebral Artery Stenosis

“…Atherosclerotic plaques can show various manifestations. Some phenotypes remain stable, but others have a close relationship with stroke events . Conventional luminal imaging techniques, such as computed tomography angiography (CTA), digital subtraction angiography (DSA), and time‐of‐flight magnetic resonance angiography (TOF‐MRA) cannot evaluate the plaque visually .…”

MRI of plaque characteristics and relationship with downstream perfusion and cerebral infarction in patients with symptomatic middle cerebral artery stenosis

“…Severe stenosis was traditionally considered to be an indicative of cerebral ischemia. However, it is increasingly recognized that the disconnect between stenosis severity and the presence of ischemic stroke is common . Recent studies using high‐resolution intracranial vessel wall imaging (HRVWI) have shown that atherosclerotic plaque characteristics, such as plaque enhancement and positive remodeling, are potential high‐risk biomarkers for ischemic stroke .…”

“…However, it is increasingly recognized that the disconnect between stenosis severity and the presence of ischemic stroke is common. [5][6][7] Recent studies using high-resolution intracranial vessel wall imaging (HRVWI) have shown that atherosclerotic plaque characteristics, such as plaque enhancement and positive remodeling, are potential high-risk biomarkers for ischemic stroke. 6,[8][9][10][11] Therefore, plaque characteristics may be a link between stenosis and ischemia.…”

Association Between Plasma Lipoprotein-Associated Phospholipase A2 and Plaque Vulnerability in TIA Patients With Unilateral Middle Cerebral Artery Stenosis

“…However, they cannot exhibit the wall morphology and atherosclerosis objectively. Although intracranial arterial stenosis is related to the occurrence of ischemic events (21), current studies have shown that the occurrence of ischemic events in patients with symptomatic intracranial atherosclerosis is more relevant to the characteristics of a plaque rather than arterial stenosis by working with HRMRI (22). Therefore, it may be more important to evaluate plaque vulnerability in terms of predicting the risk of ischemic events rather than simply assess arterial stenosis (23).…”