Association of residual stenosis after balloon angioplasty with vessel wall geometries in intracranial atherosclerosis

BackgroundPercutaneous transluminal balloon angioplasty (PTBA) may be an alternative treatment for patients with symptomatic intracranial atherosclerotic disease (ICAD) refractory to medical treatment. This study aimed to investigate the association of vessel wall geometric characteristics on high-resolution magnetic resonance vessel wall imaging (MR-VWI) with low residual stenosis in patients with ICAD after PTBA.MethodsPatients with symptomatic ICAD who underwent PTBA were prospectively and consecutively enrolled. High-resolution MR-VWI was performed before the PTBA. Vessel wall geometries of the target artery, including normalized wall index (NWI: wall area/vessel area × 100%), normalized wall thickness index (NWTI: mean wall thickness/vessel radius × 100%), and remodeling index (RI) were evaluated. Low residual stenosis was defined as postprocedural stenosis degree ≤50%. Perioperative complications including symptomatic ischemic stroke/intracranial hemorrhage, death, and arterial dissection were recorded. The baseline characteristics, vessel wall geometries, and perioperative complications were compared between the patients with low residual stenosis and high residual stenosis.ResultsAmong 60 patients prospectively enrolled, low residual stenosis was achieved in 46 participants (77%). Three patients (5%) suffered from symptomatic ischemic stroke within 30 days. Multivariable logistic regression showed that a lower NWI and lower NWTI were associated with low residual stenosis after PTBA (adjusted OR 0.57, 95% CI 0.35 to 0.94, p=0.027; and adjusted OR 0.88, 95% CI 0.80 to 0.98, p=0.015).ConclusionsLower NWI and NWTI of the target artery on high-resolution MR-VWI were associated with low residual stenosis in patients with ICAD after PTBA.

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Abstract WMP48: 3D MR Vessel Wall Imaging Reveals Plaque-Specific Responses to Medical Therapy in Patients With Symptomatic Intracranial Atherosclerotic Disease: Initial Experience

Stroke ◽

10.1161/str.51.suppl_1.wmp48 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Jiayu Xiao ◽

Huijuan Miao ◽

Song Shlee ◽

Konrad Schlick ◽

Tao Jiang ◽

...

Keyword(s):

Ischemic Stroke ◽

Medical Therapy ◽

Wall Thickness ◽

Vessel Wall ◽

Plaque Volume ◽

Post Contrast ◽

Intracranial Atherosclerotic Disease ◽

Maximum Wall Thickness ◽

Wall Imaging

Introduction: Intracranial atherosclerotic disease (ICAD) is a common cause of ischemic stroke worldwide and carries a high rate of recurrence. Follow-up of symptomatic ICAD routinely relies on assessment of lumen stenosis. Magnetic resonance vessel wall imaging (MR-VWI) has recently demonstrated the potential to reliably quantify plaque features. This work presents our experience in using serial MR-VWI to quantify the morphological changes of culprit lesions in response to medical therapy in patients with symptomatic ICAD. Methods: Twenty-four patients (4 females; age 46.75±14.05 years) with acute ischemic stroke secondary to ICAD underwent baseline (1-44 days after onset) and follow-up (3-15 months after baseline) 3D whole-brain MR-VWI, which was used to acquire pre- and post-contrast images. Quantitative plaque features, including plaque volume, peak normalized wall index (pNWI), maximum wall thickness, stenosis degree, pre-contrast plaque-wall contrast ratio (CR), and post-contrast plaque enhancement ratio (ER), were derived from both baseline and follow-up MR-VWI scans. Patients with 18-month clinical follow-up were divided into progression and non-progression groups depending on whether major vascular events (stroke, TIA, death) occurred. Results: Seventeen patients were categorized into the non-progression group and 4 into the progression group. Maximum wall thickness (P=0.047), CR (P=0.020) and ER (P=0.012) showed significant decreases in the non-progression group. In the progression group, all 4 patients showed an increase in pNWI, stenosis degree and CR; plaque volume, maximum wall thickness and ER increased in three patients. Typical cases are shown in Figure. Conclusions: Quantitative assessment of lesion-specific responses to medical therapy is clinically feasible with serial MR-VWI. The changes of plaque over time may be useful for ischemic stroke risk stratification with implications for ICAD medical management.

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Nonstenotic Culprit Plaque: The Utility of High-Resolution Vessel Wall MRI of Intracranial Vessels after Ischemic Stroke

Case Reports in Radiology ◽

10.1155/2015/356582 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

Adam de Havenon ◽

Chun Yuan ◽

David Tirschwell ◽

Thomas Hatsukami ◽

Yoshimi Anzai ◽

...

Keyword(s):

Ischemic Stroke ◽

High Resolution ◽

Vessel Wall ◽

Imaging Technique ◽

Cryptogenic Stroke ◽

The United States ◽

Resonance Imaging ◽

Thromboembolic Stroke ◽

Clinical Events ◽

Intracranial Atherosclerotic Disease

Intracranial atherosclerotic disease (ICAD) accounts for 9–15% of ischemic stroke in the United States. Although highly stenotic ICAD accounts for most of the strokes, it is assumed that nonstenotic ICAD (nICAD) can result in stroke, despite being missed on standard luminal imaging modalities. We describe a patient with nICAD who suffered recurrent thromboembolic stroke and TIA but had a negative conventional stroke workup. As a result, they were referred for high-resolution magnetic resonance imaging (HR-MRI) of the arterial vessel wall, which identified a nonstenotic plaque with multiple high-risk features, identifying it as the etiology of the patient’s thromboembolic events. The diagnosis resulted in a transition from anticoagulation to antiplatelet therapy, after which the patient’s clinical events resolved. HR-MRI is an imaging technique that has the potential to guide medical management for patients with ischemic stroke, particularly in cryptogenic stroke.

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Abstract 205: Longitudinal Study of Intracranial Atherosclerosis Using 3D High Resolution MRI Imaging

Stroke ◽

10.1161/str.48.suppl_1.205 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Xuefeng Zhang ◽

Huan Yang ◽

Mona Shahriari ◽

Li Liu ◽

Yiyi Zhang ◽

...

Keyword(s):

High Resolution ◽

Wall Thickness ◽

Vessel Wall ◽

Time Interval ◽

Black Blood ◽

Plaque Progression ◽

Intracranial Atherosclerotic Disease ◽

Maximum Wall Thickness ◽

The Mean

Hypothesis: The progression of asymptomatic intracranial atherosclerotic disease (ICAD) remains relatively unknown. We sought to determine whether the progression of ICAD over 24 months can be quantitatively detected using 3D high-resolution vessel wall MRI. Methods: 28 participants with identified ICAD (14 male; mean age, 80.1±4.94 years, ranges, 71 to 89) were enrolled from Atherosclerosis Risk in Communities Study. The baseline MRI exams were performed on a 3T Siemens scanner that included 3D time-of-flight MRA and 3D black blood MRI (BBMRI) (e.g., acquired resolution: TOF, 0.55 x 0.5 x 0.5 mm 3 ; BBMRI, 0.5 mm 3 ) for identifying atherosclerosis in major intracranial arteries. The follow-up MRI exams were repeated to determine the progression of ICAD. The mean time interval between two scans was 2.65±1.48 years. Three trained readers independently measured the degree of stenosis, plaque thickness, and normalized wall index for both normal wall and identified plaques in both visits. Plaque progression was defined by plaque showing > 2 measurement error of increase in plaque thickness. Reliability was assessed by intraclass correlations (ICC). Results: Inter- and intra-reader reliability for MRI measurements ranged from fair to excellent (ICC, 0.58-0.82). The mean coefficient of variation was 10% for mean wall thickness, 13% for maximum wall thickness and 12% for normalized wall index. Of the 28 participants with ICAD identified at baseline, 18 of 28 participants (64%) had either new plaques or evidence of plaque progression. A total of 152 and 163 plaques were identified at baseline and follow-up, respectively. Among 152 plaques, 45 (30%) progressed, and mean, maximum wall thickness, stenosis and normalized wall index increased 36%, 28%, 27% and 14%, respectively (Table 1). Conclusion: 3D High-resolution vessel wall MRI is reliable tool for measuring changes in ICAD plaque and provides insight into the natural history of ICAD progression in general population.

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Abstract TP400: The Differences of Vessel Wall Features Between the Anterior and Posterior Brain Arteries Detected by High Resolution Magnetic Resonance Imaging in Patients With Acute Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.tp400 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Xiangyan Chen ◽

Lu Zheng ◽

Jia LI ◽

Wenjie Yang

Keyword(s):

Magnetic Resonance Imaging ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

High Resolution ◽

Acute Ischemic Stroke ◽

Vessel Wall ◽

Posterior Circulation ◽

Intraplaque Hemorrhage ◽

Resonance Imaging ◽

Anterior Circulation

Backgrounds: The purpose of this study was to investigate vessel wall features visualization by high resolution magnetic resonance imaging (HRMRI) in a series of ischemic stroke patients and to identify differences between lesions in the anterior and posterior circulation. Methods: We consecutively recruited Chinese patients with acute ischemic stroke or transient ischemic attack from 2016 to 2018. All patients were scanned at 3T magnetic resonance imaging. We evaluated pre-and post-contrast cross-sectional views of M1 and M2 segments of middle cerebral arteries (MCAs), basilar arteries (BA) and V4 segments of vertebral arteries (VAs). Results: A total of 74 patients (males 52.3%; median age 62 years old) were included in this study, among which, 234 lesions were identified on HRMRI, including 117 MCA lesions, 26 BA lesions, and 91 VA lesions. The sensitivity and specificity of MRA for diagnosing stenosis in anterior circulation were 89.3% (95% CI, 81.8%- 94.2%) and 50.0 (95% CI, 9.2%- 90.8%). The sensitivity and specificity of MRA for diagnosing stenosis in posterior circulation were 73.2% (95% CI, 63.9%- 80.9%) and 40.0 (95% CI, 7.3%- 83.0%). VA had a significantly higher contrast enhancement index (43.71± 7.74, p <0.016) than MCA (23.32± 2.46) or BA (22.69± 5.31) . Anterior circulation plaques had higher degree of stenosis (anterior versus posterior: 68.5% vs. 62.9%, p =0.036), more eccentric distribution (anterior versus posterior: 70.1% versus 53.8%, p =0.015) and higher rate of intraplaque hemorrhage (anterior versus posterior: 17.1% versus 7.7%, p =0.046). The plaques in posterior circulation had a thicker lesion wall (posterior versus anterior 16.58± 8.25 mm 2 vs. 9.10± 4.07 mm 2 , p <0.001) and higher enhancement index (posterior versus anterior 39.04± 8.50 vs. 23.32± 2.46, p <0.001) than the plaques in anterior circulation. Conclusions: The lesions in posterior circulations could be obscure on MRA. The area stenosis, intraplaque hemorrhage and enhancement index differed between circulations.

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High-Resolution Magnetic Resonance Vessel Wall Imaging in Intracranial Atherosclerotic Disease

Advances in Clinical Radiology ◽

10.1016/j.yacr.2019.05.005 ◽

2019 ◽

Vol 1 ◽

pp. 193-214

Author(s):

Ramez N. Abdalla ◽

Donald R. Cantrell ◽

Alireza Vali ◽

Michael C. Hurley ◽

Ali Shaibani ◽

...

Keyword(s):

Magnetic Resonance ◽

High Resolution ◽

Vessel Wall ◽

Vessel Wall Imaging ◽

Atherosclerotic Disease ◽

Intracranial Atherosclerotic Disease ◽

Wall Imaging

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Development of a high resolution MRI intracranial atherosclerosis imaging phantom

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012974 ◽

2017 ◽

Vol 10 (2) ◽

pp. 143-149 ◽

Cited By ~ 4

Author(s):

Ju-Yu Chueh ◽

Kajo van der Marel ◽

Matthew J Gounis ◽

Todd LeMatty ◽

Truman R Brown ◽

...

Keyword(s):

High Resolution ◽

Vessel Wall ◽

Cone Beam Ct ◽

Absolute Difference ◽

Patient Specific ◽

Fibrous Cap ◽

Intracranial Atherosclerotic Disease ◽

High Resolution Mri ◽

Atherosclerosis Imaging ◽

Stenotic Vessel

Background and purposeCurrently, there is neither a standard protocol for vessel wall MR imaging of intracranial atherosclerotic disease (ICAD) nor a gold standard phantom to compare MR sequences. In this study, a plaque phantom is developed and characterized that provides a platform for establishing a uniform imaging approach for ICAD.Materials and methodsA patient specific injection mold was 3D printed to construct a geometrically accurate ICAD phantom. Polyvinyl alcohol hydrogel was infused into the core shell mold to form the stenotic artery. The ICAD phantom incorporated materials mimicking a stenotic vessel and plaque components, including fibrous cap and lipid core. Two phantoms were scanned using high resolution cone beam CT and compared with four different 3 T MRI systems across eight different sites over a period of 18 months. Inter-phantom variability was assessed by lumen dimensions and contrast to noise ratio (CNR).ResultsQuantitative evaluation of the minimum lumen radius in the stenosis showed that the radius was on average 0.80 mm (95% CI 0.77 to 0.82 mm) in model 1 and 0.77 mm (95% CI 0.74 to 0.81 mm) in model 2. The highest CNRs were observed for comparisons between lipid and vessel wall. To evaluate manufacturing reproducibility, the CNR variability between the two models had an average absolute difference of 4.31 (95% CI 3.82 to 5.78). Variation in CNR between the images from the same scanner separated by 7 months was 2.5–6.2, showing reproducible phantom durability.ConclusionsA plaque phantom composed of a stenotic vessel wall and plaque components was successfully constructed for multicenter high resolution MRI standardization.

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Utility of intracranial high-resolution vessel wall magnetic resonance imaging in differentiating intracranial vasculopathic diseases causing ischemic stroke

Neuroradiology ◽

10.1007/s00234-019-02157-5 ◽

2019 ◽

Vol 61 (4) ◽

pp. 389-396 ◽

Cited By ~ 6

Author(s):

Praveen Kesav ◽

Balamurali Krishnavadana ◽

Chandrasekharan Kesavadas ◽

Sapna E. Sreedharan ◽

Adhithyan Rajendran ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

High Resolution ◽

Vessel Wall ◽

Resonance Imaging

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Abstract TP84: Prognostic Factor of Intracranial Vertebral Artery Dissection: High Resolution Vessel Wall Magnetic Resonance Imaging Study

Stroke ◽

10.1161/str.51.suppl_1.tp84 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Jae-Hwan Kim ◽

Hyung Jun Kim ◽

Ye Sel Kim ◽

Woo-Keun Seo ◽

Oh Young Bang ◽

...

Keyword(s):

Ischemic Stroke ◽

High Resolution ◽

Prognostic Factor ◽

Vertebral Artery ◽

Vessel Wall ◽

Independent Predictor ◽

Vertebral Artery Dissection ◽

Posterior Circulation ◽

Artery Dissection ◽

Poor Outcomes

Background: Vertebral artery dissection (VAD) is well recognized cause of stroke in young and middle aged individuals. But, prognostic factor of posterior circulation ischemic stroke or transient ischemic attack (TIA) caused by intracranial VAD has been rarely discussed. Our aim was to evaluate the predictors of poor outcomes in posterior circulation ischemic stroke caused by intracranial VAD. Methods: We retrospectively reviewed patients with posterior circulation ischemic stroke or TIA caused by intracranial VAD using high-resolution vessel wall MRI who were recruited from Samsung Medical Center Stroke Registry (between January 1, 2011 and April 30, 2019). Poor outcomes were defined as a 3-months modified Rankin scale (mRS) score ≥ 2. Results: We registered 96 patients (74 males; mean age, 58.9±14.2 years) with acute posterior circulation ischemic stroke or TIA caused by intracranial VAD. Trauma history associated with VAD was presented in 23 (24%) of patients. Headache and neck pain around neurological symptom onset were presented in 41 (42.7%) and 19 (19.8%) of patients, respectively. Dissecting aneurysm, bilateral vertebral artery involvement, basilar artery involvement and wall hematoma with dissection were presented in 26 (27.1%), 26 (27.1%), 12 (12.5%) and 66 (68.8%) of patients, respectively. Of the 96 VADs, 26 (27.1%) presented with focal stenosis, 21 (21.9%) with multifocal stenosis, and 57 (59.4%) with occlusion. Lateral medulla involvement and multiple territory involvement were presented in 35 (36.5%) and 31 (32.3%) of patients. Recurrence rate of ischemic stroke or TIA within 90 days of symptom onset was 6.25%. Twenty-nine patients (30.2%) had poor outcomes at 3 months. Lateral medulla involvement was an independent predictor for poor outcome (odds ratio=3.293, 95% confidence interval=1.301-8.333, p=0.012). Conclusion: Posterior circulation ischemic stroke or TIA caused by intracranial VAD is associated with relatively benign clinical course. But the presence of lateral medulla involvement is independent predictor for poor outcome. Patients presenting lateral medullary infarction caused by intracranial VAD should be monitored closely.

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Spontaneous intracranial vertebral artery dissection with acute ischemic stroke: High-resolution magnetic resonance imaging findings

The Neuroradiology Journal ◽

10.1177/1971400918764129 ◽

2018 ◽

Vol 31 (3) ◽

pp. 262-269 ◽

Cited By ~ 4

Author(s):

Soo Young Yun ◽

Young Jin Heo ◽

Hae Woong Jeong ◽

Jin Wook Baek ◽

Hye Jung Choo ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Ischemic Stroke ◽

High Resolution ◽

Diffusion Mri ◽

Vertebral Artery Dissection ◽

Intramural Hematoma ◽

Artery Dissection ◽

Resonance Imaging ◽

Mri Findings ◽

Remodeling Index

Background Acute ischemic stroke (AIS) more frequently develops in patients with intracranial vertebral artery dissection (VAD) than extracranial VAD, and is associated with possible poor clinical outcomes. The aim of this study is to compare high-resolution magnetic resonance imaging (HR-MRI) findings and clinical features of VAD with and without AIS. Methods Twenty-nine lesions from 27 patients (15 male and 12 female patients; age range = 28–73 years) who underwent diffusion MRI and 3T HR-MRI within seven days were included. We classified VAD according to the presence of AIS lesions on diffusion MRI. Clinical features and HR-MRI findings (angiographic patterns, presence of double lumen sign, dissecting flap, posterior inferior cerebellar artery involvement, remodeling index, length of affected vessels, T1-signal intensity, area of intramural hematoma, and grades and patterns of vessel wall enhancement) were evaluated. Results Thirteen VADs with AIS and 16 without AIS were included. There were no significant differences in the clinical parameters (sex, age, risk factors, symptoms). More VADs with AIS presented as a steno-occlusive pattern than VADs without AIS. More VADs without AIS presented with aneurysmal dilation, larger mean remodeling index and longer mean length than VADs with AIS. Presence of intramural hematoma, T1-iso-signal intensity of intramural hematoma and contrast enhancement were significantly more common in VADs with AIS than without AIS. Conclusions Our study showed some differences in HR-MRI comparing intracranial VAD patients with and without AIS. Differing findings may facilitate a better understanding of intracranial VAD and risk assessment of AIS in these patients.

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