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Vessel Shrinkage and Stroke Recurrence in Intracranial Atherosclerotic Stenosis Under Intensive Lipid-Lowering

Weizhuang Yuan1, Zhongrui Yan2, Baoquan Lu3

  • 1Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases (W.Y., X.H., Caiyan Liu, Y.X., W.-H.X.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing.

Stroke
|August 20, 2025
PubMed

Insights

Intensive lipid-lowering therapy can cause outer-wall boundary changes in intracranial atherosclerotic stenosis. Shrinkage of this boundary significantly increases the risk of recurrent stroke, highlighting its clinical importance.

Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Radiology

Background:

  • Intracranial atherosclerotic stenosis (ICAS) poses a significant risk for ischemic stroke.
  • The dynamic changes in the vessel wall, particularly the outer-wall boundary, during intensive lipid-lowering therapy are not well understood.
  • Understanding these changes is crucial for assessing treatment efficacy and predicting clinical outcomes in ICAS patients.

Purpose of the Study:

  • To investigate the dynamic changes of the outer-wall boundary area in patients with ICAS undergoing intensive lipid-lowering therapy.
  • To evaluate the association between outer-wall boundary area changes and the risk of recurrent ipsilateral stroke.

Main Methods:

  • A multicenter cohort study included 137 patients with first-ever acute ischemic stroke due to ICAS receiving high-dose statins and PCSK9 inhibitors.
  • High-resolution 3D T1-weighted MRI vessel wall imaging was performed at baseline and after a >6-month follow-up.
  • Outer-wall boundary area changes were categorized as expansion, shrinkage, or quiescence, and their association with recurrent stroke was analyzed using Kaplan-Meier and Cox regression models.

Main Results:

  • Among 137 patients, 36.5% showed expansion, 29.2% shrinkage, and 34.3% quiescence of the outer-wall boundary area.
  • Plaque burden decreased significantly in all groups, while lumen area increased in expansion and quiescence groups, but not in the shrinkage group.
  • Shrinkage of the outer-wall boundary area was significantly associated with an increased risk of recurrent ipsilateral stroke (HR, 2.95; P=0.046), an association that persisted after multivariable adjustment (HR, 4.21; P=0.031).

Conclusions:

  • Outer-wall boundary area dynamics vary considerably in ICAS patients under intensive lipid-lowering therapy.
  • Shrinkage of the outer-wall boundary area is a significant imaging biomarker predicting a higher risk of stroke recurrence.
  • These findings underscore the importance of monitoring outer-wall boundary changes for risk stratification and personalized treatment strategies in ICAS.
Abstract

Keywords:
atherosclerosisconstriction, pathologicischemic strokeplaque, atheroscleroticrecurrence

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