Abstract
Background Intracranial atherosclerosis is an important cause of ischemic stroke and is associated with several vascular risk factors. Current imaging is mainly based on the assessment of luminal narrowing rather than abnormalities in the vessel wall. Purpose To investigate the relationship between vascular risk factors and atherosclerotic lesion burden of intracranial arteries assessed with vessel wall MRI at 7 T in participants with ischemic stroke or transient ischemic attack (TIA). Materials and Methods In this prospective study (trial identification number: NTR2119; www.trialregister.nl), study participants who presented with ischemic stroke or TIA of the anterior circulation between December 2009 and September 2017 underwent pre- and postcontrast 7-T vessel wall MRI within 3 months of symptom onset. All large arteries of the intracranial circulation were assessed for number, location, and enhancement of vessel wall lesions. Generalized estimating equations for Poisson regression were used to investigate the relationship between vascular risk factors and number or enhancement of vessel wall lesions. Results Ninety participants (52 men; mean age, 60 years) were evaluated. Increasing age (relative risk [RR], 1.02; 95% confidence interval [CI]: 1.01, 1.03), hypertension (RR, 1.46; 95% CI: 1.06, 2.02), diabetes mellitus (RR, 1.67; 95% CI: 1.20, 2.33), and a higher multivariable vascular risk score (Second Manifestations of Arterial Disease risk score) (RR, 1.01; 95% CI: 1.00, 1.02) were associated with a higher number of vessel wall lesions in the anterior circulation. Contrast material-enhancing vessel wall lesions were associated only with increasing age (RR, 1.03; 95% CI: 1.01, 1.05). No association was found between smoking and the number of vessel wall lesions. Conclusion Except for smoking, traditional common cardiovascular risk factors were associated with a higher number and enhancement of intracranial vessel wall lesions at 7-T MRI in individuals evaluated after ischemic stroke or transient ischemic attack. Published under a CC BY 4.0 license. Online supplemental material is available for this article.
Highlights
Materials and MethodsIn this prospective study (trial identification number: NTR2119; www.trialregister.nl), study participants who presented with ischemic stroke or TIA of the anterior circulation between December 2009 and September 2017 underwent pre- and postcontrast 7-T vessel wall MRI within 3 months of symptom onset
Increasing age, hypertension, diabetes mellitus, and a higher vascular risk score were associated with a higher number of intracranial vessel wall lesions when assessed with 7-T MRI in a white study sample with stroke or transient ischemic attack, whereas no statistically significant relationship was seen for smoking and dyslipidemia
Key Results n Increasing age, hypertension (RR, 1.46; P = .02), diabetes mellitus (RR, 1.67; P = .003), and a higher multivariable vascular risk score (Second Manifestations of Arterial Disease risk score) (RR, 1.01; P = .004) were associated with a higher number of vessel wall lesions in the anterior circulation when assessed with 7-T MRI
Summary
Study Participants From December 2009 to September 2017, patients who presented to University Medical Center Utrecht with ischemic stroke or TIA of the anterior circulation could be included in the intracranial vessel wall imaging study (trial identification number: NTR2119, www.trialregister.nl). The Second Manifestations of Arterial Disease (SMART) vascular risk score was calculated to combine risk factors (age, sex, current smoking status, systolic blood pressure, diabetes mellitus, coronary artery disease, cerebrovascular disease, abdominal aortic aneurysm, peripheral artery disease, time since first diagnosis of cardiovascular disease, high-density lipoprotein cholesterol, total cholesterol, estimated glomerular filtration rate, and high-sensitivity C-reactive protein) into one score [26] This score predicts the 10-year risk of recurrent vascular events in participants with clinically manifest atherosclerosis. For participants who underwent imaging during the first 1.5 years of the study with the smaller FOV MPIR-TSE sequence, the posterior circulation could not be completely assessed for vessel wall lesions because the vertebral artery and basilar artery were often outside the FOV. Generalized estimating equations for Poisson regression were performed to assess the relationship between vascular risk factors and the number of enhancing vessel wall lesions in the anterior circulation. Statistical analyses were performed with software (SPSS, version 21.0; IBM SPSS Statistics, Armonk, NY)
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