Abstract
Contrast-enhanced 3T high-resolution MR imaging can be used to determine the wall enhancement pattern of the basilar artery in symptomatic atherosclerotic stenosis. We used this method to explore the relationship between wall enhancement and both recent infarction in the territory of the stenotic BA and subsequent ischemic events associated with the stenotic BA. Sixty patients with symptomatic atherosclerotic BA stenosis ≥70% were enrolled consecutively. HR-MRI of cross-sectional BAs was obtained before and after contrast media injection, and wall enhancement indices were calculated for sections proximal to, at, and distal to the site of maximal luminal narrowing. DWI of the brain was performed to determine the presence of recent infarction. Images from 56 patients were suitable for analysis. Thirty-three patients underwent stent placement for the stenotic BA, and 23 patients underwent conservative medical treatment with antiplatelet agents and risk-factor control. All 23 patients with medical treatment had a 12-month follow-up. Greater wall enhancement was seen in the section proximal to the MLN section in both patients with recent infarction (74 ± 65% versus 44 ± 44%; P = .046) and in patients with subsequent ischemic events (100 ± 57% versus 44 ± 44%; P = .014). Greater wall enhancement proximal to the MLN site correlates with recent infarction in the territory of the stenotic BA and subsequent ischemic events associated with the stenotic BA. Contrast-enhanced HR-MRI may serve as a noninvasive tool for risk stratification of BA atherosclerosis.
Highlights
MethodsSixty patients with symptomatic atherosclerotic BA stenosis Ն70% were enrolled consecutively
BACKGROUND AND PURPOSEContrast-enhanced 3T high-resolution MR imaging can be used to determine the wall enhancement pattern of the basilar artery in symptomatic atherosclerotic stenosis
Greater wall enhancement was seen in the section proximal to the MLN section in both patients with recent infarction (74 Ϯ 65% versus 44 Ϯ 44%; P ϭ .046) and in patients with subsequent ischemic events (100 Ϯ 57% versus 44 Ϯ 44%; P ϭ .014)
Summary
Sixty patients with symptomatic atherosclerotic BA stenosis Ն70% were enrolled consecutively. Patients This study was approved by our institutional ethics committees, and written informed consent was obtained before each HR-MRI examination. From December 2007 to April 2012, 60 consecutive patients were enrolled in this study. The enrollment criteria were as follows: 1) ischemic stroke or transient ischemic attack in the posterior cerebral circulation within 90 days; 2) Ն70% BA stenosis verified by conventional angiography; and 3) 1 or more atherosclerotic risk factors, including hypertension, hyperlipidemia, diabetes mellitus, cigarette smoking, and obesity (body mass index Ն30 kg/m2). Patients with the following conditions were excluded: arteritis, contraindication to MRI, medical instability precluding MRI, concomitant bilateral vertebral artery stenoses of Ն50%, no atherosclerotic risk factors, known atrial fibrillation on electrocardiogram (past or present), rheumatic heart disease, metallic heart valve, and/or myocardial infarction within 3 months. We screened a total of 64 patients, and 4 patients were excluded
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