Risk Factors of New Cerebral Infarctions After Endovascular Treatment for Basilar Artery Stenosis Based on High-Resolution Magnetic Resonance Imaging.

Jichang Luo,Yan Ma,Yao Feng,Long Li,Liqun Jiao,Renjie Yang,Peng Gao,Kun Yang,Bin Yang,Tao Wang

doi:10.3389/fneur.2020.620031

Abstract

Objective: The current study aims to analyze the risk factors of new cerebral infarctions in the distribution of basilar artery (BA) detected by diffusion-weighted imaging (DWI) after endovascular treatment in patients with severe BA stenosis.Methods: Data was collected from the electronic medical records of patients with severely atherosclerotic basilar artery stenosis (≥70%) who underwent endovascular treatment. The plaque characteristics, including the plaque distribution, plaque burden, plaque enhancement index, remodeling ratio, and stenosis degree, were evaluated qualitatively and quantitatively using high-resolution magnetic resonance imaging (HR-MRI) and digital subtraction angiography (DSA). The characteristics of the procedure, such as the type of treatment, balloon diameter, balloon length, stent diameter, and stent length, were analyzed.Results: A total of 107 patients with severe basilar artery stenosis (≥70%) who underwent endovascular treatment were enrolled. The study participants included 77 men and 30 women, with an average age of 61.6 ± 8.1 years. The rate of postoperative new cerebral infarctions was 55.1% (59/107), of which 74.6% (44/59) were caused by artery-to-artery embolism, 6.8% (4/59) due to perforator occlusion, and 18.6% (11/59) were caused by a mixed mechanism. Twelve of 59 patients had ischemic events, with nine cases of stroke and three cases of transient ischemic attacks (TIA). The plaque burden in the DWI-positive group was significantly larger than that in the DWI-negative group (3.7% vs. −8.5%, p = 0.016). Positive remodeling was more common in the DWI-positive group than in the DWI-negative group (35.6% vs. 16.7%, p = 0.028). Smoking was inversely correlated with the rate of new cerebral infarctions (odds ratio, 0.394; 95% confidence interval, 0.167–0.926; p = 0.033).Conclusion: The plaque characteristics are not associated with new cerebral infarctions in the distribution of BA, although a large plaque burden and positive remodeling are more likely to appear in patients with new cerebral infarctions after BA stenting, which warrants further studies with a larger sample size. As for smoking, the inverse correlation with new cerebral infarctions in the BA territory needs large-scale prospective randomized controlled trials to verify.

Highlights

Basilar artery (BA) atherosclerotic stenosis is a common cause of transient ischemic attacks (TIA) and stroke, accounting for approximately 20% of symptomatic ischemic infarctions of the posterior circulation [1]
We retrospectively explored the risk factors of new cerebral infarctions in the BA territory detected by diffusion-weighted imaging (DWI) after endovascular treatment for BA stenosis based on High-resolution magnetic resonance imaging (HR-magnetic resonance imaging (MRI)) in Chinese individuals
Some patients were excluded based on the following criteria: [1] Acute BA occlusion treated by endovascular therapy; [2] endovascular therapy for another intracranial and extracranial vessel disease simultaneously; [3] BA stenosis accompanied with moderate-tosevere stenosis of the vertebral artery; [4] non-atherosclerotic cause of BA stenosis, such as Moyamoya disease, vasculitis, or vascular dissection; and [5] preoperative DWI suggested largearea cerebral infarctions (≥1/2)

Summary

Introduction

Basilar artery (BA) atherosclerotic stenosis is a common cause of transient ischemic attacks (TIA) and stroke, accounting for approximately 20% of symptomatic ischemic infarctions of the posterior circulation [1]. Endovascular therapy is an effective alternative treatment for drug-refractory BA stenosis. The new cerebral infarction rate detected by diffusion-weighted imaging (DWI) may be higher given that the definition of stroke is the combination of new cerebral infarctions on DWI and clinical symptoms of neurological deficits, as well as some new cerebral infarctions that have no clinical symptoms and are only detected by DWI [3]. Some studies have reported that the prevalence of new cerebral infarctions discovered by DWI is as high as 70% after endovascular treatment [4, 5]

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