Deans' stroke musings: Factors for Enhancement of Intracranial Atherosclerosis in High Resolution Vessel Wall MRI in Ischemic Stroke Patients

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, July 7, 2020

Factors for Enhancement of Intracranial Atherosclerosis in High Resolution Vessel Wall MRI in Ischemic Stroke Patients

So you have identified a way to find a problem. WHAT THE FUCK IS THE SOLUTION TO REMOVING THAT PLAQUE? Useless research then with no solution.

Factors for Enhancement of Intracranial Atherosclerosis in High Resolution Vessel Wall MRI in Ischemic Stroke Patients

Na-Eun Woo¹,

Han Kyu Na¹,

Ji Hoe Heo¹,

Hyo Suk Nam¹,

Jin Kyo Choi¹,

Sung Soo Ahn²,

Hyun Seok Choi²,

Seung-Koo Lee²,

Hye Sun Lee³,

Jihoon Cha²^* and

Young Dae Kim¹^*

¹Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
²Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
³Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, South Korea

Introduction: High resolution vessel wall MRI (VW-MRI) has enabled to characterize intracranial atherosclerosis (ICAS). We studied to identify the factors for enhancement of ICAS in VW-MRI in patients with acute ischemic stroke.

Methods: Consecutive patients with acute ischemic stroke or TIA who underwent VW-MRI between January 2017 and December 2017 were included. Enhancement on VW-MRI was defined as an increase in intensity on contrast-enhanced T1-weighted sequence. We compared the clinical and the radiologic findings between patients with wall enhancement and those without wall enhancement.

Results: Of the 48 patients with ICAS, 28 patients revealed enhancement on VW-MRI. Patients with enhancement were more likely to have severe stenotic lesions and higher levels of total cholesterol, triglycerides, low-density cholesterol, Apo (b), and Apo (b)/Apo (a) lipoprotein ratio (p < 0.05). Multivariable analysis demonstrated that total cholesterol (OR: 5.378, 95% CI, 1.779–16.263), triglycerides (OR: 3.362, 95% CI, 1.008–11.209), low density lipoprotein cholesterol (OR: 4.226, 95% CI, 1.264–14.126), Apo (b) lipoprotein (OR: 3639.641, 95% CI, 17.854–741954.943) levels, and Apo (b)/Apo (a) lipoprotein ratio (OR, 65.514; 95% CI, 1.131–3680.239) were independently associated with enhancement of ICAS. High-density lipoprotein cholesterol and Apo (a) lipoprotein levels were not significantly different between the patients with wall enhancement and those without wall enhancement.

Conclusions: The presence and severity of enhancement of ICAS was significantly associated with dyslipidemic conditions. These results suggest that strict lipid modification should be achieved for the management of ICAS.

Introduction

Ischemic stroke is a major cause of mortality and morbidity worldwide (1). Atherosclerosis, in particular, intracranial atherosclerosis (ICAS), is recognized as one of the most common etiological factors of ischemic stroke accounting for 30–50% of the ischemic cerebrovascular events (2). Moreover, ischemic stroke attributable to ICAS is known to be associated with an increased risk of poor functional outcomes after stroke, cognitive impairment, and vascular death (3). Precise in vivo characterization of ICAS is crucial, as this knowledge enables the clinicians to better stratify the stroke risk for individual patients and to plan therapeutic strategies accordingly.

Conventionally, clinicians have focused primarily on detection and estimation of the degree of luminal stenosis by using luminography techniques such as digital subtraction angiography or magnetic resonance angiography (MRA). However, luminography alone is insufficient to fully determine the histopathologic composition and instability of the plaque (4, 5). Currently, the advent of high resolution vessel wall magnetic resonance imaging (VW-MRI) has enabled clinicians to differentiate among various intracranial vasculopathies and to characterize the vulnerability of ICAS plaque, which is thought to be the culprit lesion of ischemic events, and the degree of luminal stenosis (6–9). Among the VW-MRI findings, contrast enhancement of the ICAS plaque is increasingly being reported as a reliable marker of plaque vulnerability. It also tends to be predictive of future cerebrovascular events (4, 10, 11). However, the factors for the presence or extent of arterial wall enhancement on VW-MRI are not fully understood (12, 13).

In the present study, we aimed to identify the factors for the enhancement of ICAS in VW-MRI in patients with acute ischemic stroke.