Intracranial collaterals and arterial wall features in severe symptomatic vertebrobasilar stenosis
Ming Yang1,2, Ning Ma2, Liping Liu1
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases , Beijing, China.
Insights
Good intracranial collateral status in the posterior circulation may reduce the risk of arterial positive remodeling and plaque enhancement in severe symptomatic intracranial vertebrobasilar atherosclerosis (sIVBAS). This finding highlights the importance of collateral circulation in stroke prevention.
Area of Science:
- Neurology
- Vascular Biology
- Medical Imaging
Background:
- The role of intracranial collaterals in plaque vulnerability in severe symptomatic intracranial vertebrobasilar atherosclerosis (sIVBAS) is not well understood.
- Understanding these relationships can inform stroke risk stratification and management.
Purpose of the Study:
- To investigate the association between intracranial collateral status and arterial wall features.
- To examine arterial remodeling and culprit plaque characteristics in patients with sIVBAS based on collateral status.
Main Methods:
- A prospective observational study included patients with posterior circulation stroke or TIA due to sIVBAS.
- Three-dimensional high-resolution MRI (3D HRMRI) was used for detailed arterial and plaque analysis.
- Patients were categorized into poor and good collateral groups using a modified semiquantitative grading system.
Main Results:
- Seventy-four patients were analyzed (39 poor, 35 good collateral).
- Good collateral status was associated with a lower likelihood of arterial positive remodeling (Adjusted OR = 0.17) and plaque enhancement (Adjusted OR = 0.17).
- No significant differences in intraplaque hemorrhage or calcification were observed between groups.
Conclusions:
- Good intracranial collateral circulation in the posterior circulation appears protective.
- It is linked to reduced arterial positive remodeling and less plaque enhancement in sIVBAS.
- These findings suggest collateral status is a key factor in sIVBAS plaque vulnerability.
Background And Aims:
The protective role of intracranial primary collaterals on plaque vulnerability is not well established. We aimed to explore the association of intracranial collateral status with arterial wall features including arterial remodeling and culprit plaque features in severe symptomatic intracranial vertebrobasilar atherosclerosis (sIVBAS).
Methods:
Posterior circulation stroke or TIA patients owing to sIVBAS from a three-dimensional high-resolution MRI (3D HRMRI) prospective observational study was included for current analysis. Participants were dichotomized into poor and good collateral groups according to a modified semiquantitative grading system for primary collateral of posterior circulation. Differences of arterial remodeling, culprit plaque distribution, enhancement, intraplaque hemorrhage (IPH), and calcification on HRMRI were compared between the two groups.
Results:
Seventy-four eligible patients were included, wherein 39 in poor collateral group and 35 in good collateral group. The average age was 57.0 ± 9.0 years, 65 (87.8%) were male, 62 (83.8%) were diagnosed with ischemic stroke and 12 (16.2%) with TIA. Patients with good collateral had lower occurrence of arterial positive remodeling and plaque diffuse distribution, enhancement (Adjusted OR = 0.17 [0.05-0.54], p < 0.01; adjusted OR = 0.26 [0.06-0.99], p = 0.05; adjusted OR = 0.17 [0.03-0.96], p = 0.04, respectively). No significant differences on IPH and calcification were found between poor and good collateral group (p > 0.05).
Conclusion:
Intracranial good collateral of posterior circulation may be associated with lower risk of arterial positive remodeling and culprit plaque diffuse distribution, plaque enhancement in patients with severe sIVBAS.
Trial Registration:
clinicaltrials.gov Identifier: NCT02705599.
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