Translesional pressure gradient and leptomeningeal collateral status in symptomatic middle cerebral artery stenosis

Leng, Xinyi; Lan, Linfang; Ip, Hing Lung; Fan, Florence; H., S.; Ma, Karen; Liu, H.; Yan, Zhengzheng; Liu, J.; Abrigo, Jill; Soo, Yannie; Liebeskind, David S; Wong, Ka Sing; Leung, Thomas W.

doi:10.1111/ene.13521

Cited by 26 publications

(43 citation statements)

References 25 publications

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“…CTA was performed in helical mode with no tilting, covering from the base of the skull to the cortical regions well above the lateral ventricles, slice thickness = 0.5 to 0.6 mm. 19 Leptomeningeal collateral assessment of all cases was conducted centrally at PWH by one investigator (L.L.) 18 In patients with sICAS in the anterior circulation, the leptomeningeal collateral status was assessed by defining the laterality of anterior cerebral artery (ACA) and posterior cerebral artery (PCA) in maximum intensity projections of CTA in the axial and coronal planes, in OsiriX version 8.0.1 (Pixmeo, Geneva, Switzerland), as described in our previous work.…”

Section: Assessment Of Sicas and Leptomeningealmentioning

confidence: 99%

“…[19][20][21] (1) Three-dimensional geometry of the arteries of interest was reconstructed from CTA source images, covering the intracranial ICA, MCA-M1, and ACA-A1 segments for cases with an ICA or MCA-M1 lesion; and VA-V4, BA, and PCA-P1 segments for cases with a VA-V4 or BA lesion. CFD modeling procedures were described in our previous work.…”

Section: Cfd Modeling and Quantification Of Hemodynamic Features Of Smentioning

confidence: 99%

“…19 Ipsilesional leptomeningeal collateral status was considered good when distal pials in ipsilesional ACA or PCA territory, or both territories, was more prominent than on the contralateral side; otherwise the leptomeningeal collateral status was considered poor. 19 Leptomeningeal collateral assessment of all cases was conducted centrally at PWH by one investigator (L.L.) blinded to clinical information; uncertainties were resolved by consulting a second investigator (X.L.…”

Section: Assessment Of Sicas and Leptomeningeal Collaterals By Ctamentioning

confidence: 99%

“…CFD modeling procedures were described in our previous work. [19][20][21] (1) Three-dimensional geometry of the arteries of interest was reconstructed from CTA source images, covering the intracranial ICA, MCA-M1, and ACA-A1 segments for cases with an ICA or MCA-M1 lesion; and VA-V4, BA, and PCA-P1 segments for cases with a VA-V4 or BA lesion. (2) A mesh was then created on the vessel surface and within the vessel lumen in ANSYS ICEM CFD, with the maximal element sizes of 0.1 for the inlet(s) and outlets and 0.25 for other parts of the mesh, containing 0.5 to 1 million elements in total for each case.…”

Section: Cfd Modeling and Quantification Of Hemodynamic Features Of Smentioning

confidence: 99%

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Hemodynamics and stroke risk in intracranial atherosclerotic disease

Leng

Lan

et al. 2019

Annals of Neurology

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Objective: To investigate whether hemodynamic features of symptomatic intracranial atherosclerotic stenosis (sICAS) might correlate with the risk of stroke relapse, using a computational fluid dynamics (CFD) model. Methods: In a cohort study, we recruited patients with acute ischemic stroke attributed to 50 to 99% ICAS confirmed by computed tomographic angiography (CTA). With CTA-based CFD models, translesional pressure ratio (PR = pressure poststenotic /pressure prestenotic ) and translesional wall shear stress ratio (WSSR = WSS stenotic − throat /WSS prestenotic ) were obtained in each sICAS lesion. Translesional PR ≤ median was defined as low PR and WSSR ≥4th quartile as high WSSR. All patients received standard medical treatment. The primary outcome was recurrent ischemic stroke in the same territory (SIT) within 1 year. Results: Overall, 245 patients (median age = 61 years, 63.7% males) were analyzed. Median translesional PR was 0.94 (interquartile range [IQR] = 0.87-0.97); median translesional WSSR was 13.3 (IQR = 7.0-26.7). SIT occurred in 20 (8.2%) patients, mostly with multiple infarcts in the border zone and/or cortical regions. In multivariate Cox regression, low PR (adjusted hazard ratio [HR] = 3.16, p = 0.026) and high WSSR (adjusted HR = 3.05, p = 0.014) were independently associated with SIT. Patients with both low PR and high WSSR had significantly higher risk of SIT than those with normal PR and WSSR (risk = 17.5% vs 3.0%, adjusted HR = 7.52, p = 0.004). Interpretation: This work represents a step forward in utilizing computational flow simulation techniques in studying intracranial atherosclerotic disease. It reveals a hemodynamic pattern of sICAS that is more prone to stroke relapse, and supports hypoperfusion and artery-to-artery embolism as common mechanisms of ischemic stroke in such patients. ANN NEUROL 2019;85:752-764 I ntracranial atherosclerotic stenosis (ICAS) is a major cause of ischemic stroke in Asian populations, contributing to 30 to 50% of ischemic stroke and transient ischemic attack (TIA). 1,2 In earlier pivotal trials on treatment of symptomatic ICAS (sICAS) patients, such as the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial, risk of recurrent stroke and death was up to 15% at 1 year among those with 50 to 99% sICAS treated with aspirin. 3 In the last few years, risk of recurrent stroke in such patients has decreased with better cardiovascular risk factor management, but still higher than stroke patients without ICAS. For instance, among minor stroke or high-risk TIA patients treated with aspirin plus clopidogrel for 21 days followed by clopidogrel mono therapy for days 22 to 90 in the View this article online at wileyonlinelibrary.com.

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Section: Assessment Of Sicas and Leptomeningealmentioning

confidence: 99%

Section: Cfd Modeling and Quantification Of Hemodynamic Features Of Smentioning

confidence: 99%

Section: Assessment Of Sicas and Leptomeningeal Collaterals By Ctamentioning

confidence: 99%

Section: Cfd Modeling and Quantification Of Hemodynamic Features Of Smentioning

confidence: 99%

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Hemodynamics and stroke risk in intracranial atherosclerotic disease

Leng

Lan

et al. 2019

Annals of Neurology

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“…Thirdly, the haemodynamic impact of intracranial disease is often inferred by the presence of new and old infarctions in classical haemodynamic territories, as watershed areas, but it is not the only causative mechanism of stroke in these patients, as artery‐to‐artery embolism and parent artery disease are the main mechanisms of stroke. The authors did not report data about the stroke pattern, so it is not possible to discuss this point. Haemodynamic and embolic risk can coexist and influence each other .…”

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confidence: 99%

Pressure and pipes: from neuroimaging to virtual measurement

Zedde

Pascarella

2018

Euro J of Neurology

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Watershed subarachnoid hemorrhage after middle cerebral artery rescue stenting in patients with acute ischemic stroke

et al. 2021

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Cortical subarachnoid hemorrhage is an infrequent subtype of non-aneurysmal subarachnoid hemorrhage, rarely reported in watershed territories (wSAH) after carotid stenting. It has never been reported after treatment of middle cerebral artery stenosis (MCAS) that is increasingly used in selected patients, as rescue treatment of failed mechanical thrombectomy, due to recent advancements in endovascular interventions. We present a series of patients with MCAS that developed a wSAH after stenting.

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Translesional pressure gradient and leptomeningeal collateral status in symptomatic middle cerebral artery stenosis

Abstract: Our study suggested a correlation between translesional pressure gradient and maturation of LMCs in intracranial atherosclerotic disease. Further studies with more exquisite and dynamic monitoring of cerebral hemodynamics and LMC evolution are needed to verify the current findings.

Cited by 26 publications

References 25 publications

Hemodynamics and stroke risk in intracranial atherosclerotic disease

Hemodynamics and stroke risk in intracranial atherosclerotic disease

Pressure and pipes: from neuroimaging to virtual measurement

Watershed subarachnoid hemorrhage after middle cerebral artery rescue stenting in patients with acute ischemic stroke

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