Luminal and Wall Changes in Intracranial Arterial Lesions for Predicting Stroke Occurrence

Abstract

Background and Purpose: Luminal imaging (degree of stenosis) currently serves as the gold standard to predict stroke recurrence and guide therapeutic strategies in patients with intracranial large artery diseases (ILADs). We comparatively evaluated the importance of vessel wall and luminal changes in predicting stroke occurrence. Methods: Consecutive patients with ILAD in the proximal middle cerebral artery or distal internal carotid artery without proximal sources of embolism from the carotid and heart underwent time-of-flight magnetic resonance angiography, high-resolution magnetic resonance imaging, and the ring finger protein 213 ( RNF213 ) gene variant test. Patients were followed up for >3 months. Results: Of the 675 patients, 241 (35.7%) had atherosclerotic ILAD and 434 (64.3%) showed nonatherosclerotic ILAD (315 [46.7%] moyamoya disease cases and 119 [17.6%] dissection cases). The RNF213 variant was detected in 74.9%, 33.6%, and 3.4% patients with moyamoya disease, atherosclerosis, and dissection, respectively. Three hundred (44.4%) patients had asymptomatic ILAD, whereas 375 (55.6%) patients had symptomatic ILAD. Multivariate analysis showed that vessel enhancement and etiological subtypes, not degree of stenosis, determined by high-resolution magnetic resonance imaging and RNF213 gene variant analysis were independently associated with symptomatic ILAD. The presence of the RNF213 variant was also independently associated with recurrent cerebrovascular events. Conclusions: This study demonstrates the prevalence of nonatherosclerotic ILAD in East Asian patients with ILAD. Unlike luminal changes, wall changes determined by high-resolution magnetic resonance imaging and presence of the RNF213 variant could predict stroke occurrence in patients with ILADs.

Vessel Wall Magnetic Resonance Imaging Biomarkers of Symptomatic Intracranial Atherosclerosis

“…37 Recent work suggests vessel wall changes, such as enhancement, maybe more important than luminal changes in predicting stroke occurrence. 38 In a longitudinal study, Kim et al 28 reported a 30.3% 1-year event rate of stroke recurrence in the presence of plaque enhancement, compared with 6.8% in the nonenhancing plaque group. Identifying patients at greatest risk for recurrence with a predictive marker would be invaluable to help implement more aggressive therapies or continue them for a longer duration.…”

Correlation of the characteristics of symptomatic intracranial atherosclerotic plaques with stroke types and risk of stroke recurrence: a cohort study

“…High-resolution vessel wall imaging (HR-VWI) is currently an important diagnostic technique for assessing atherosclerosis. It can not only accurately assess the degree of vascular luminal stenosis but also provide the size and composition information of plaques with extremely high repeatability (8,9). Recurrent strokes tend to be more severe and have a worse prognosis than primary strokes, Early identification of patients at high risk of recurrent stroke is important.…”

Black‐Blood Contrast in Cardiovascular MRI

“…91 Modern black-blood MRI techniques of the carotid bifurcation are highly accurate for identifying carotid atherosclerosis, including intraplaque hemorrhage 92,93 and patients at increased risk for stroke. [94][95][96] Although imaging the vessel wall of medium-sized arteries is possible at a field strength of 1.5T, 97-99 use of higher field strengths such as 3.0T and 7.0T allow 3D isotropic submillimeter spatial resolution acquisitions while maintaining sufficient SNR and has been shown to significantly improve coronary artery vessel wall image quality, 100,101 depiction of atherosclerosis in small intracranial arteries, 102,103 (Fig. 9) and even plaque rupture in patients with acute myocardial infarction.…”

“…A recent technique permits 3D acquisition and simultaneous depiction of the vessel wall and the vascular lumen using a combined bright‐ and black‐blood imaging sequence 91 . Modern black‐blood MRI techniques of the carotid bifurcation are highly accurate for identifying carotid atherosclerosis, including intraplaque hemorrhage 92,93 and patients at increased risk for stroke 94–96 …”

“… 91 Modern black‐blood MRI techniques of the carotid bifurcation are highly accurate for identifying carotid atherosclerosis, including intraplaque hemorrhage 92 , 93 and patients at increased risk for stroke. 94 , 95 , 96 …”