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Updated: Aug 11, 2025
Author Spotlight: Assessing Ischemic Stroke Damage Through Middle Cerebral Artery Occlusion Model
Published on: August 11, 2023
Wall Shear Stress Associated with Stroke Occurrence and Mechanisms in Middle Cerebral Artery Atherosclerosis
Ho Geol Woo1, Hyug-Gi Kim2, Kyung Mi Lee2
1Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea.
Background And Purpose:
Various mechanisms are involved in the etiology of stroke caused by atherosclerosis of the middle cerebral artery (MCA). Here, we compared differences in plaque nature and hemodynamic parameters according to stroke mechanism in patients with MCA atherosclerosis.
Methods:
Consecutive patients with asymptomatic and symptomatic MCA atherosclerosis (≥50% stenosis) were enrolled. MCA plaque characteristics (location and plaque enhancement) and wall shear stress (WSS) were measured using high-resolution vessel wall and four-dimensional flow magnetic resonance imaging, respectively, at five points (initial, upstream, minimal lumen, downstream, and terminal). These parameters were compared between patients with asymptomatic and symptomatic MCA atherosclerosis with infarctions of different mechanisms (artery-to-artery embolism vs. local branch occlusion).
Results:
In total, 110 patients (46 asymptomatic, 32 artery-to-artery embolisms, and 32 local branch occlusions) were investigated. Plaques were evenly distributed in the MCA of patients with asymptomatic MCA atherosclerosis, more commonly observed in the distal MCA of patients with artery-to-artery embolism, and in the middle MCA of patients with local branch occlusion. Maximum WSS and plaque enhancement were more prominent in the minimum lumen area of patients with asymptomatic MCA atherosclerosis or those with local branch occlusion, and were more prominent in the upstream area in those with artery-to-artery embolism. The elevated variability in the maximum WSS was related to stroke caused by artery-to-artery embolism.
Conclusion:
Stroke caused by artery-to-artery embolism was related to plaque enhancement and the highest maximum WSS at the upstream point of the plaque, and was associated with elevated variability of maximum WSS.
Insights
Stroke caused by artery-to-artery embolism is linked to plaque enhancement and higher wall shear stress (WSS) upstream. Elevated WSS variability also indicates this stroke mechanism in middle cerebral artery atherosclerosis.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Medical Imaging
Background:
- Atherosclerosis of the middle cerebral artery (MCA) can lead to stroke through various mechanisms.
- Understanding plaque characteristics and hemodynamics is crucial for differentiating stroke causes.
Purpose of the Study:
- To compare plaque nature and hemodynamic parameters in patients with MCA atherosclerosis based on stroke mechanism.
- To investigate differences between asymptomatic MCA atherosclerosis, artery-to-artery embolism, and local branch occlusion.
Main Methods:
- High-resolution vessel wall and 4D flow MRI were used to assess MCA plaque characteristics and wall shear stress (WSS).
- Measurements were taken at five points along the MCA in patients with asymptomatic, artery-to-artery embolism, and local branch occlusion related strokes.
- Plaque location, enhancement, and WSS were compared across groups.
Main Results:
- Plaque distribution varied: evenly in asymptomatic, distal MCA in embolism, and middle MCA in local occlusion.
- Maximum WSS and plaque enhancement were prominent in the minimum lumen area (asymptomatic/local occlusion) or upstream area (embolism).
- Elevated variability in maximum WSS correlated with artery-to-artery embolism strokes.
Conclusions:
- Artery-to-artery embolism strokes are associated with plaque enhancement and maximal WSS at the upstream plaque point.
- Elevated variability of maximum WSS is a key indicator for stroke caused by artery-to-artery embolism.
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