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High-Risk Intracranial Atherosclerotic Stenosis Despite Aggressive Medical Treatment: Protocol for a Prospective

Tao Wang1,2, Jichang Luo1,2, Changyi Liu3

  • 1China International Neuroscience Institute (China-INI), Beijing, China.

Frontiers in Neurology
|May 2, 2022
PubMed

Insights

This study identifies multimodal imaging predictors for high-risk intracranial atherosclerotic disease (ICAD) patients who experience recurrent strokes despite medical treatment. It aims to refine stroke risk stratification beyond traditional stenosis measurements.

Area of Science:

  • Neurology
  • Cardiovascular Imaging
  • Stroke Medicine

Background:

  • Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke, particularly in Asia.
  • Aggressive medical therapy for ICAD still results in high rates of recurrent stroke, especially with severe stenosis.
  • Current risk stratification relies mainly on luminal stenosis, but plaque characteristics and hemodynamics are emerging as crucial factors.

Purpose of the Study:

  • To identify multimodal imaging predictors of high-risk ICAD patients refractory to medical treatment.
  • To develop a refined risk stratification model for ICAD using advanced imaging techniques.
  • To improve stroke risk assessment in patients with symptomatic intracranial atherosclerosis.

Main Methods:

  • Prospective, longitudinal, nested case-control study of 400 symptomatic ICAD patients (50-99% stenosis).
  • Multimodal imaging assessment including lumen stenosis, plaque characteristics, and hemodynamic features.
  • Aggressive medical management with antiplatelet therapy and cardiovascular risk control.

Main Results:

  • The study is designed to identify imaging markers predictive of recurrent ischemic stroke or death within 1 year.
  • It will analyze associations between imaging features and primary outcomes (ischemic stroke/death) and secondary endpoints (any stroke, mortality, functional outcome).
  • Results will provide insights into novel predictors beyond traditional stenosis measures.

Conclusions:

  • This research will establish a refined risk stratification model for ICAD based on multimodal imaging.
  • Findings are expected to enhance the identification of patients at high risk for recurrent stroke.
  • The study aims to improve clinical decision-making and patient outcomes in ICAD management.
Abstract

Keywords:
hemodynamicsintracranial atherosclerosismedical treatmentprotocolvessel wall

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