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.
Highlights
Intracranial atherosclerotic disease was one of the major causes of ischemic stroke throughout the world (Amarenco et al, 1994; Arenillas, 2011; Banerjee and Chimowitz, 2017), accounting for about 10% of transient ischemic attack and 30%-50% of ischemic stroke (Qureshi et al, 2009), and it was the most common factor in the Asian population (Arenillas, 2011; Yang et al, 2016)
The criteria of patients enrollment in this study included: (1) single MCA M1 segment stenosis >30% showed on MRA; (2) two or more athersclerotic risk factors; (3) without contraindications to MR scan; (4) the stenosis of ipsilateral internal carotid artery less than 50%; (5) the quality of pictures could be used for diagnosis and analysis; (6) without non-atherosclerotic vasculopathy, such as vasculitis, moyamoya disease, dissection, cerebral hemorrhage, tumor etc.; (7) no evidence of arterial fibrillation, cardioembolism
The measurement work was done by two professional radiologists (W-D Z and JS) who were blinded to clinical details in 2 days after scanning, and the average value
Summary
Intracranial atherosclerotic disease was one of the major causes of ischemic stroke throughout the world (Amarenco et al, 1994; Arenillas, 2011; Banerjee and Chimowitz, 2017), accounting for about 10% of transient ischemic attack and 30%-50% of ischemic stroke (Qureshi et al, 2009), and it was the most common factor in the Asian population (Arenillas, 2011; Yang et al, 2016). MCA was the commonest atherosclerotic stenotic location in Asian (Wong et al, 2002). It was thought that stenotic grade of MCA was the most accurate reflection of the ischemic stroke risk (Lehrke et al, 2009). It was thought that intracranial atherosclerosis should be evaluated with stenotic grade and characteristics of vessel wall (Chung et al, 2012; Zhu et al, 2013; Zhao et al, 2015). PR in carotid arteries was more common in patients with cerebral ischemic symptoms (Hardie et al, 2007). Since the MCA had similar structures and components with the coronary arteries and carotid arteries, arterial remodeling of MCA might share the same vascular biological features (Shi et al, 2012). The direct relationships between the MCA and the arterial remodeling still remain unclear
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