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Published on: December 7, 2013
Hemodynamics and stroke risk in intracranial atherosclerotic disease
Xinyi Leng1,2, Linfang Lan1,3, Hing Lung Ip1
1Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China.
Insights
Hemodynamic features like low pressure ratio and high wall shear stress ratio in symptomatic intracranial atherosclerotic stenosis (sICAS) predict stroke relapse. These findings aid in identifying high-risk patients for targeted stroke prevention strategies.
Area of Science:
- Neurology
- Biomedical Engineering
- Medical Imaging
Background:
- Symptomatic intracranial atherosclerotic stenosis (sICAS) is a significant cause of ischemic stroke.
- Predicting stroke relapse in sICAS patients remains a clinical challenge.
- Computational fluid dynamics (CFD) offers a novel approach to analyze hemodynamic features.
Purpose of the Study:
- To investigate the correlation between hemodynamic features of sICAS and the risk of stroke relapse.
- To utilize CFD models to assess pressure ratio (PR) and wall shear stress ratio (WSSR) in sICAS lesions.
- To identify specific hemodynamic patterns associated with recurrent ischemic stroke in the same territory (SIT).
Main Methods:
- A cohort study included 245 patients with 50-99% ICAS confirmed by CTA.
- CTA-based CFD models were used to calculate translesional PR and WSSR.
- Patients were categorized based on median PR (low PR) and 4th quartile WSSR (high WSSR).
- The primary outcome was SIT within 1 year, analyzed using multivariate Cox regression.
Main Results:
- Low PR (HR=3.16) and high WSSR (HR=3.05) were independently associated with an increased risk of SIT.
- Patients with both low PR and high WSSR exhibited a significantly higher risk of SIT (HR=7.52) compared to those with normal hemodynamic parameters.
- SIT occurred in 8.2% of patients, often with multiple infarcts in border zone or cortical regions.
Conclusions:
- Hemodynamic patterns characterized by low PR and high WSSR in sICAS are significant predictors of stroke relapse.
- CFD analysis provides valuable insights into the mechanisms of stroke in sICAS, including hypoperfusion and artery-to-artery embolism.
- These findings support the use of CFD in risk stratification and management of patients with sICAS.
Objective:
To investigate whether hemodynamic features of symptomatic intracranial atherosclerotic stenosis (sICAS) might correlate with the risk of stroke relapse, using a computational fluid dynamics (CFD) model.
Methods:
In a cohort study, we recruited patients with acute ischemic stroke attributed to 50 to 99% ICAS confirmed by computed tomographic angiography (CTA). With CTA-based CFD models, translesional pressure ratio (PR = pressurepoststenotic /pressureprestenotic ) and translesional wall shear stress ratio (WSSR = WSSstenotic - throat /WSSprestenotic ) were obtained in each sICAS lesion. Translesional PR ≤ median was defined as low PR and WSSR ≥4th quartile as high WSSR. All patients received standard medical treatment. The primary outcome was recurrent ischemic stroke in the same territory (SIT) within 1 year.
Results:
Overall, 245 patients (median age = 61 years, 63.7% males) were analyzed. Median translesional PR was 0.94 (interquartile range [IQR] = 0.87-0.97); median translesional WSSR was 13.3 (IQR = 7.0-26.7). SIT occurred in 20 (8.2%) patients, mostly with multiple infarcts in the border zone and/or cortical regions. In multivariate Cox regression, low PR (adjusted hazard ratio [HR] = 3.16, p = 0.026) and high WSSR (adjusted HR = 3.05, p = 0.014) were independently associated with SIT. Patients with both low PR and high WSSR had significantly higher risk of SIT than those with normal PR and WSSR (risk = 17.5% vs 3.0%, adjusted HR = 7.52, p = 0.004).
Interpretation:
This work represents a step forward in utilizing computational flow simulation techniques in studying intracranial atherosclerotic disease. It reveals a hemodynamic pattern of sICAS that is more prone to stroke relapse, and supports hypoperfusion and artery-to-artery embolism as common mechanisms of ischemic stroke in such patients. Ann Neurol 2019;85:752-764.
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