Abstract
BackgroundTo evaluate the relationship between the flow signal intensity of branch arteries distal to the stenosis on 3-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) and the risk of stroke recurrence in patients with severe middle cerebral artery (MCA) trunk stenosis.MethodsWe prospectively recruited 153 patients (mean age 62.9 ± 13.0 years, 106 males) with a first ischemic stroke or transient ischemic attack caused by a severe MCA trunk stenosis (70 % to 99 %) confirmed by 3D TOF MRA and followed them for one year to determine the stroke recurrence. The MCA branch signal intensity distal to the site of stenosis on 3D TOF MRA was classified as either good (grade A) or poor [mild reduction (grade B) or severe reduction (grade C)] according to the extent to which the MCA could be visualized. The patients were divided into groups A (35), B (58), or C (60) based on the MRA grading of the MCA branch signal intensity distal to the site of stenosis.ResultsPoor MCA branch signal intensity was associated with internal border-zone infarction (p < 0.05). The risk of stroke recurrence in the ipsilateral MCA in the first year was 18.3 %. The 1-year cumulative incidence of recurrence was higher in the patients in group C (30 %) than in groups B (12.1 %) or A (8.6 %) (Log rank, p = 0.007). Multivariate analyses via Cox proportional hazard regression demonstrated that only a grade C classification of the signal intensity of the MCA branches was an independent predictor of stroke recurrence in the ipsilateral MCA (hazard ratio = 3.0, 95 % confidence interval = 1.3-7.4, p = 0.014).ConclusionsThis study demonstrated that MCA branch signal intensity as assessed via 3D TOF MRA may be a useful and simple tool to stratify the risk of stroke recurrence in patients with severe MCA trunk stenosis.
Highlights
To evaluate the relationship between the flow signal intensity of branch arteries distal to the stenosis on 3-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) and the risk of stroke recurrence in patients with severe middle cerebral artery (MCA) trunk stenosis
Previous studies have demonstrated that the visibility of the MCA stem or branches on MRA is associated with the hemodynamic status in the cerebral hemisphere with ipsilateral internal carotid artery (ICA) occlusive diseases and that the visibility of the MCA ipsilateral to carotid endarterectomy (CEA) on preoperative MRA may be useful for identifying patients who are at risk for cerebral hyperperfusion or ischemic events after CEA [25,26,27]
The risk of recurrence in the first year in our patients treated with aspirin or clopidogrel was similar to that in patients with symptomatic severe intracranial artery stenosis (ICAS) treated with aspirin or warfarin in the Warfarin Aspirin Symptomatic Intracranial Disease (WASID) study [6], but was higher than that in patients of the medical arm of SAMMPRIS trial [11], which may be due to the facts that aggressive medical management used in the SAMMPRIS trial was not used to the same extent in our patients
Summary
To evaluate the relationship between the flow signal intensity of branch arteries distal to the stenosis on 3-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) and the risk of stroke recurrence in patients with severe middle cerebral artery (MCA) trunk stenosis. Several recent studies have used the signal intensity ratio (SIR) across the stenosis lesion on MRA to assess the change in signal intensity across an ICAS and observed that a decrease in SIR may be associated with hemodynamic disorders and a high risk of stoke recurrence [22,23,24]. Previous studies have demonstrated that the visibility of the MCA stem or branches on MRA is associated with the hemodynamic status in the cerebral hemisphere with ipsilateral internal carotid artery (ICA) occlusive diseases and that the visibility of the MCA ipsilateral to carotid endarterectomy (CEA) on preoperative MRA may be useful for identifying patients who are at risk for cerebral hyperperfusion or ischemic events after CEA [25,26,27]
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