Intracranial Atherosclerotic Plaque Morphologic Pattern and Enhancement Change With High-Intensity Statin Therapy

Area of Science:

• Neuroimaging
• Cardiovascular Research
• Medical Therapy

Background:

• Gadolinium contrast enhancement in plaque imaging may indicate instability and treatment response.
• High-resolution vessel wall imaging (HR-VWI) is utilized to assess plaque morphology and enhancement changes.
• This study focuses on evaluating plaque changes after high-intensity statin therapy.

Purpose of the Study:

• To evaluate changes in plaque morphology and gadolinium enhancement using HR-VWI.
• To assess the impact of high-intensity statin therapy on intracranial atherosclerotic disease.
• To determine if HR-VWI can monitor plaque response to medical treatment.

Main Methods:

• Seven-Tesla (7-T) HR-VWI was performed at baseline and follow-up (≥6 months) in patients with stroke/TIA due to intracranial atherosclerosis.
• T1 and T1+gadolinium sequences were acquired; plaque burden, stenosis, and gadolinium enhancement were quantified.
• Low-density lipoprotein (LDL) levels were monitored throughout maximal medical therapy.

Main Results:

• Five patients showed decreased plaque burden (76% to 60%), area degree of stenosis (61% to 56%), and gadolinium uptake (4.11 to 3.76) at follow-up.
• LDL levels decreased from 122 to 111 mg/dL.
• Lower follow-up LDL correlated with reduced plaque burden (r=0.86), stenosis (r=0.8), and gadolinium uptake (r=0.82).

Conclusions:

• High-intensity statin therapy led to changes in plaque morphology and reduced gadolinium uptake.
• HR-VWI demonstrates potential for evaluating plaque response to medical interventions.
• These findings suggest plaque stabilization in response to aggressive lipid-lowering treatment.