Black blood vessel wall MRI to identify vulnerable atherosclerotic plaque in a non-stenotic intracranial vertebral artery as a cause of acute ischaemia

Conventional neuroimaging techniques for investigating the cause of stroke are mainly centred on investigating luminal stenosis. The pathophysiology of intracranial atherosclerotic disease (ICAD) and stroke is complex and extends beyond just vessel narrowing. The concept of the vulnerable atherosclerotic plaque, that can result in acute coronary syndromes, has been well described in the cardiac literature 1,2 although this concept is less well accepted among stroke physicians. We describe a case of a 61-year-old male with acute neurological sequelae from a non-stenotic atherosclerotic plaque of the intracranial vertebral artery. This case report describes the additional use of vessel wall MRI techniques to aid the radiologist in identifying such vulnerable lesions and therefore helping to tailor management and prevent further clinical deterioration.

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Acute coronary syndromes: Targeting the vulnerable atherosclerotic plaque – new approaches for stabilization and regression of the plaque

Drug Discovery Today Therapeutic Strategies ◽

10.1016/j.ddstr.2008.05.004 ◽

2008 ◽

Vol 5 (1) ◽

pp. 37-43 ◽

Cited By ~ 1

Author(s):

Sivaram Pillarisetti ◽

Uday Saxena

Keyword(s):

Atherosclerotic Plaque ◽

Acute Coronary Syndromes ◽

Vulnerable Atherosclerotic Plaque ◽

New Approaches ◽

Coronary Syndromes

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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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High-Resolution Black-Blood MRI of the Carotid Vessel Wall Using Phased-Array Coils at 1.5 and 3 Tesla1

Academic Radiology ◽

10.1016/j.acra.2005.08.009 ◽

2005 ◽

Vol 12 (12) ◽

pp. 1521-1526 ◽

Cited By ~ 23

Author(s):

SeshaSailaja Anumula ◽

Hee Kwon Song ◽

Alexander C. Wright ◽

Felix W. Wehrli

Keyword(s):

High Resolution ◽

Vessel Wall ◽

Phased Array ◽

Black Blood ◽

Black Blood Mri ◽

Carotid Vessel Wall ◽

Phased Array Coils ◽

Array Coils ◽

Carotid Vessel

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Phase-sensitive black-blood coronary vessel wall imaging

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/1532-429x-11-s1-o11 ◽

2009 ◽

Vol 11 (S1) ◽

Cited By ~ 1

Author(s):

Khaled Z Abd-Elmoniem ◽

Matthias Stuber

Keyword(s):

Vessel Wall ◽

Vessel Wall Imaging ◽

Coronary Vessel ◽

Black Blood ◽

Coronary Vessel Wall ◽

Phase Sensitive ◽

Wall Imaging

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Precise theranostic nanomedicines for inhibiting vulnerable atherosclerotic plaque progression through regulation of vascular smooth muscle cell phenotype switching

Theranostics ◽

10.7150/thno.24364 ◽

2018 ◽

Vol 8 (13) ◽

pp. 3693-3706 ◽

Cited By ~ 11

Author(s):

Sai Ma ◽

Seyed Mohammad Motevalli ◽

Jiangwei Chen ◽

Meng-Qi Xu ◽

Yabin Wang ◽

...

Keyword(s):

Smooth Muscle ◽

Vascular Smooth Muscle ◽

Smooth Muscle Cell ◽

Muscle Cell ◽

Atherosclerotic Plaque ◽

Cell Phenotype ◽

Plaque Progression ◽

Vulnerable Atherosclerotic Plaque ◽

Smooth Muscle Cell Phenotype ◽

Phenotype Switching

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Microsurgical Endarterectomy of the Intracranial Vertebral Artery for Vertebrobasilar Transient Ischemic Attacks

Neurosurgery ◽

10.1227/00006123-198101000-00011 ◽

1981 ◽

Vol 8 (1) ◽

pp. 56-59 ◽

Cited By ~ 31

Author(s):

George S. Allen ◽

Ronald J. Cohen ◽

Thomas J. Preziosi

Keyword(s):

Vertebral Artery ◽

Brain Stem ◽

Antiplatelet Therapy ◽

Atherosclerotic Plaque ◽

Basilar Artery ◽

Neurological Deficit ◽

Operating Microscope ◽

Transient Ischemic Attacks

Abstract Two patients who had typical vertebrobasilar transient ischemic attacks (TIAs) that were refractory to anticoagulation with dicumarol and to antiplatelet therapy with aspirin and/or dipyridamole are described. Angiography revealed in both patients a stenotic atherosclerotic plaque of the intracranial vertebral artery between the posterior and anterior inferior cerebellar arteries. At operation, the first patient had an atherosclerotic plaque extending into the basilar artery, and no endarterectomy was attempted. The second patient had a 1-cm localized plaque that was removed successfully from the vertebral artery. Neither patient sustained a neurological deficit as a result of the operation. The patient whose plaque was not removed at operation continues to have vertebrobasilar TIAs and suffered a brain stem stroke 2 weeks after operation. The patient whose plaque was removed at operation continues to be free of TIAs 8 months later, and angiography performed 3 months after operation showed a widely patent vertebral artery. A portion of the intracranial vertebral artery has now been shown to be accessible to endarterectomy using the operating microscope. Angiography is helpful in determining this accessibility preoperatively.

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