Mechanisms of ischemic stroke in patients with intracranial atherosclerosis: A high‑resolution magnetic resonance imaging study

Gao,Tianli; Yu,Wei; Liu,Chunjie

doi:10.3892/etm.2014.1600

Mechanisms of ischemic stroke in patients with intracranial atherosclerosis: A high‑resolution magnetic resonance imaging study

Authors:
- Tianli Gao
- Wei Yu
- Chunjie Liu
View Affiliations

Affiliations: Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China, Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
Published online on: March 4, 2014 https://doi.org/10.3892/etm.2014.1600
Pages: 1415-1419

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

High‑resolution magnetic resonance imaging (HRMRI) has a unique ability to provide an evaluation of the intracranial artery wall. This study aimed to investigate the possible mechanisms of ischemic stroke in patients with intracranial atherosclerosis using HRMRI. HRMRI was performed on 55 patients (38 male and 17 female) with acute cerebral infarction to investigate the lumen‑intruding plaque at the stenotic portion of the middle cerebral artery (MCA) and basilar artery (BA) and to attempt to identify the mechanisms of stroke. Penetrating artery disease (PAD) was diagnosed in 20 patients (36%) and large‑artery atherosclerosis (LAA) was diagnosed in 35 patients, including 19 with parent artery plaques occluding a penetrating artery (POPA; 35%) and 16 with artery‑to‑artery embolisms (29%). Patients with PAD had a higher frequency of hypertension compared with that of the patients with LAA (80 versus 29%; P<0.001), and patients with LAA had a higher frequency of diabetes compared with that of the patients with PAD (40% versus 15%; P=0.054). Magnetic resonance angiography revealed mild to moderate stenosis in the patients with POPA, while border zone infarction and artery‑to‑artery embolism occurred in the majority of the patients with severe stenosis or occlusion of the MCA and BA. HRMRI has the ability to identify the mechanisms of intracranial atherosclerotic ischemic stroke through the detection of luminal plaques.

View Figures

View References

1	Pu Y, Liu L, Wang Y, et al; Chinese IntraCranial AtheroSclerosis (CICAS) Study Group. Geographic and sex difference in the distribution of intracranial atherosclerosis in China. Stroke. 44:2109–2114. 2013. View Article : Google Scholar : PubMed/NCBI
2	Rincon F, Sacco RL, Kranwinkel G, et al: Incidence and risk factors of intracranial atherosclerotic stroke: the Northern Manhattan Stroke Study. Cerebrovasc Dis. 28:65–71. 2009. View Article : Google Scholar : PubMed/NCBI
3	Shi MC, Wang SC, Zhou HW, et al: Compensatory remodeling in symptomatic middle cerebral artery atherosclerotic stenosis: a high-resolution MRI and microemboli monitoring study. Neurol Res. 34:153–158. 2012.PubMed/NCBI
4	Naghavi M, Libby P, Falk E, et al: From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation. 108:1664–1672. 2003. View Article : Google Scholar
5	Xu WH, Li ML, Gao S, et al: In vivo high-resolution MR imaging of symptomatic and asymptomatic middle cerebral artery atherosclerotic stenosis. Atherosclerosis. 212:507–511. 2010. View Article : Google Scholar : PubMed/NCBI
6	Ma N, Jiang WJ, Lou X, et al: Arterial remodeling of advanced basilar atherosclerosis: a 3-tesla MRI study. Neurology. 75:253–258. 2010. View Article : Google Scholar : PubMed/NCBI
7	Bodle JD, Feldmann E, Swartz RH, Rumboldt Z, Brown T and Turan TN: High-resolution magnetic resonance imaging: an emerging tool for evaluating intracranial arterial disease. Stroke. 44:287–292. 2013. View Article : Google Scholar : PubMed/NCBI
8	Niizuma K, Shimizu H, Takada S and Tominaga T: Middle cerebral artery plaque imaging using 3-Tesla high-resolution MRI. J Clin Neurosci. 15:1137–1141. 2008. View Article : Google Scholar : PubMed/NCBI
9	Ryu CW, Jahng GH, Kim EJ, Choi WS and Yang DM: High resolution wall and lumen MRI of the middle cerebral arteries at 3 tesla. Cerebrovasc Dis. 27:433–442. 2009. View Article : Google Scholar : PubMed/NCBI
10	Gao S, Wang YJ, Xu AD, et al: Chinese ischemic stroke subclassification. Front Neurol. 2:62011.
11	Turan TN, Maidan L, Cotsonis G, et al; Warfarin-Aspirin Symptomatic Intracranial Disease Investigators. Failure of antithrombotic therapy and risk of stroke in patients with symptomatic intracranial stenosis. Stroke. 40:505–509. 2009. View Article : Google Scholar : PubMed/NCBI
12	Kim JM, Jung KH, Sohn CH, Moon J, Han MH and Roh JK: Middle cerebral artery plaque and prediction of the infarction pattern. Arch Neurol. 69:1470–1475. 2012. View Article : Google Scholar : PubMed/NCBI
13	Arenillas JF and Alvarez-Sabin J: Basic mechanisms in intracranial large-artery atherosclerosis: advances and challenges. Cerebrovasc Dis. 20(Suppl 2): 75–83. 2005. View Article : Google Scholar : PubMed/NCBI
14	Yazdani SK, Vorpahl M, Ladich E and Virmani R: Pathology and vulnerability of atherosclerotic plaque: identification, treatment options, and individual patient differences for prevention of stroke. Curr Treat Options Cardiovasc Med. 12:297–314. 2010. View Article : Google Scholar
15	Cai JM, Hatsukami TS, Ferguson MS, Small R, Polissar NL and Yuan C: Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging. Circulation. 106:1368–1373. 2002. View Article : Google Scholar : PubMed/NCBI
16	Kampschulte A, Ferguson MS, Kerwin WS, et al: Differentiation of intraplaque versus juxtaluminal hemorrhage/thrombus in advanced human carotid atherosclerotic lesions by in vivo magnetic resonance imaging. Circulation. 110:3239–3244. 2004. View Article : Google Scholar
17	Larose E, Yeghiazarians Y, Libby P, et al: Characterization of human atherosclerotic plaques by intravascular magnetic resonance imaging. Circulation. 112:2324–2331. 2005. View Article : Google Scholar : PubMed/NCBI
18	Lam WW, Wong KS, So NM, Yeung TK and Gao S: Plaque volume measurement by magnetic resonance imaging as an index of remodeling of middle cerebral artery: correlation with transcranial color Doppler and magnetic resonance angiography. Cerebrovasc Dis. 17:166–169. 2004.
19	Gao T, Zhang Z, Yu W, Zhang Z and Wang Y: Atherosclerotic carotid vulnerable plaque and subsequent stroke: a high-resolution MRI study. Cerebrovasc Dis. 27:345–352. 2009. View Article : Google Scholar : PubMed/NCBI
20	Mono ML, Karameshev A, Slotboom J, et al: Plaque characteristics of asymptomatic carotid stenosis and risk of stroke. Cerebrovasc Dis. 34:343–350. 2012. View Article : Google Scholar : PubMed/NCBI
21	Lindsay AC, Biasiolli L, Lee JM, et al: Plaque features associated with increased cerebral infarction after minor stroke and TIA: a prospective, case-control, 3-T carotid artery MR imaging study. JACC Cardiovasc Imaging. 5:388–396. 2012. View Article : Google Scholar : PubMed/NCBI
22	Pantoni L and Garcia JH: Pathogenesis of leukoaraiosis: a review. Stroke. 28:652–659. 1997. View Article : Google Scholar : PubMed/NCBI
23	Arenillas JF, Molina CA, Chacón P, et al: High lipoprotein (a), diabetes, and the extent of symptomatic intracranial atherosclerosis. Neurology. 63:27–32. 2004. View Article : Google Scholar : PubMed/NCBI
24	Thomas GN, Lin JW, Lam WW, et al: Albuminuria is a marker of increasing intracranial and extracranial vascular involvement in Type 2 diabetic Chinese patients. Diabetologia. 47:1528–1534. 2004. View Article : Google Scholar : PubMed/NCBI
25	Kwan MW, Mak W, Cheung RT and Ho SL: Ischemic stroke related to intracranial branch atheromatous disease and comparison with large and small artery diseases. J Neurol Sci. 303:80–84. 2011. View Article : Google Scholar : PubMed/NCBI