Cerebral blood flow evaluation of intensive rosuvastatin therapy in stroke/transient ischemic attack patients with intracranial arterial atherosclerotic stenosis study: Rationale and design

Abstract

IntroductionThe risk of recurrent stroke is high in patients with intracranial atherosclerotic stenosis (ICAS). Statin use has been demonstrated to decrease the incidence of stroke by reducing atherosclerotic plaque burden. However, its effect on the hemodynamic situation and cerebral perfusion status has not yet been validated. With the use of computed tomography perfusion (CTP), we aim to evaluate the impact of Rosuvastatin on cerebral hemodynamic changes, as well as the downstream perfusion.MethodCerebral bood flow evaluation of intensive rosuvastatin therapy in patients with intracranial arterial atherosclerotic stenosis (CEIRIS) is a single‐center, prospective, randomized, parallel‐group, and open‐label trial, and it will include 50 participants as estimated. Patients with moderate to severe (50%–99%) ICAS are randomized 1:1 to 10 mg/day or 20 mg/day Rosuvastatin and followed every 13 weeks until 52 weeks. The primary outcome for the trial is the change in the relative regional cerebral blood flow evaluated by CTP after 52 weeks of Rosuvastatin treatment. The secondary outcomes are cerebral blood volume, change in the degree of stenosis of the target vessel and lipid parameters.ConclusionThe CEIRIS trial about the effects of statin on the temporal hemodynamic progression of ICAS may extend our understanding of the basic pathophysiology and mechanisms of stroke in ICAS patients.

Association between symptomatic intracranial atherosclerotic disease and the integrity of the circle of Willis

“…Symptomatic intracranial atherosclerosis refers to ischemic stroke or transient ischemic attack occurring in the stenosis area of the supplying artery [1]. It is well established that the progression of the intracranial atherosclerotic disease will decrease blood perfusion and increase the risk of cerebral ischemic events [2][3][4][5][6]. During the progression of atherosclerotic cerebrovascular disease, the compensatory system can be initiated through the collateral circulation to preserve perfusion and stabilize cerebral blood flow [7][8][9][10][11].…”

Domain adaptive and fully automated carotid artery atherosclerotic lesion detection using an artificial intelligence approach (LATTE) on 3D MRI

“…Carotid atherosclerosis is a major cause of stroke and is associated with high mortality and morbidity globally 1‐3 . Atherosclerotic lesion progression leads to plaque rupture, arterial stenosis, and/or occlusion, which may cause ischemic events due to atheroembolization or hypoperfusion 4 . Luminal narrowing through angiographic approaches, such as Doppler ultrasound and CT angiography, have been used clinically to evaluate severity of carotid atherosclerosis but recent studies have shown its limitations in identifying high‐risk plaques that may cause clinical events and may miss potential embolic sources of carotid atherosclerosis and miscategorize the etiology of stroke 5‐7 …”

“…[1][2][3] Atherosclerotic lesion progression leads to plaque rupture, arterial stenosis, and/or occlusion, which may cause ischemic events due to atheroembolization or hypoperfusion. 4 Luminal narrowing through angiographic approaches, such as Doppler ultrasound and CT angiography, have been used clinically to evaluate severity of carotid atherosclerosis but recent studies have shown its limitations in identifying high-risk plaques that may cause clinical events and may miss potential embolic sources of carotid atherosclerosis and miscategorize the etiology of stroke. [5][6][7] Vessel wall imaging (VWI) with MRI of the carotid artery has been recognized to be able to identify high-risk atherosclerotic lesions and may improve diagnosis sensitivity and accuracy.…”

Quantification of morphometry and intensity features of intracranial arteries from 3D TOF MRA using the intracranial artery feature extraction (iCafe): A reproducibility study

“…Atherosclerosis is a major cause of cardio-and cerebrovascular disease mortality and morbidity globally [1][2][3]. Plaque progression leads to arterial stenosis and/or occlusion, which may cause downstream ischemic events due to atherothrombosis or hypoperfusion [4]. As a subset of atherosclerosis, intracranial atherosclerosis accounts for about 30-50% and 10% of cerebrovascular ischemic events in Asian and Caucasian populations, respectively [5].…”