Biomarkers, Natural Course and Prognosis

Area of Science:

• Neurology
• Vascular Medicine
• Cardiology

Background:

• Intracranial atherosclerosis (ICAS) is a progressive vascular disease with significant stroke and cognitive impairment risks.
• Asymptomatic ICAS is more prevalent in Asian populations and linked to vascular risk factors and metabolic syndrome.
• Symptomatic ICAS presents an aggressive, dynamic course with a high risk of recurrent stroke.

Purpose of the Study:

• To enhance understanding of intracranial atherosclerosis natural history and prognostic factors.
• To inform preventive strategies and reduce clinical consequences of ICAS.
• To review current knowledge on local and systemic factors influencing ICAS patient prognosis.

Main Methods:

• Review of population-based studies and clinical trials, including the SAMMPRIS trial.
• Analysis of prognostic factors, categorized into local (plaque characteristics) and systemic (patient factors).
• Emerging techniques like high-resolution magnetic resonance imaging (HRMRI) for in vivo arterial wall evaluation.

Main Results:

• Intensive medical therapy, as shown by the SAMMPRIS trial, effectively reduces symptomatic ICAS recurrence.
• Despite optimal therapy, symptomatic ICAS carries the highest recurrence risk among stroke subtypes.
• Research highlights inflammation as a key factor in ICAS progression and complications.

Conclusions:

• Improved knowledge of ICAS natural history and prognosis is crucial for effective prevention.
• Identifying high-risk ICAS patients requires evaluating both vulnerable plaque characteristics and systemic factors.
• Biomarker research and advanced imaging like HRMRI are vital for characterizing vulnerable ICAS patients and plaques.