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 (69). 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.

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