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

Plaque enhancement after gadolinium contrast administration may assess plaque instability and response to medical therapy. We used high-resolution vessel wall imaging to evaluate changes in plaque morphologic pattern and enhancement after treatment with high-intensity statins.

Patients with a history of stroke or transient ischemic attack attributable to intracranial atherosclerotic disease underwent 7-T high-resolution vessel wall imaging. T1 and T1+gadolinium sequences were obtained at baseline. Follow-up images were acquired at a minimum of 6 months after the initial scan. Low-density lipoprotein levels were also recorded at baseline and at follow-up, after maximal medical therapy was started. Plaque burden, degree of stenosis, and area degree of stenosis were calculated at baseline and follow-up. Gadolinium enhancement was quantified using a 3-dimensional pipeline for plaque analysis.

Five patients were included. The mean age was 56 years, and the average time to follow-up imaging was 17.7 months. Low-density lipoprotein decreased from a mean of 122 to 111 mg/dL at follow-up. Plaque burden decreased from μ=76% to 60%, area degree of stenosis decreased from μ=61% to 56%, and gadolinium uptake decreased from a mean of μ=4.11 to 3.76. Furthermore, a lower low-density lipoprotein at follow-up was correlated with decreased plaque burden (r=0.86), lower area degree of stenosis (r=0.8), and less gadolinium uptake (r=0.82).

Plaque morphologic pattern and gadolinium uptake changed at follow-up with high-intensity statin therapy. High-resolution vessel wall imaging shows promise in assessing plaque response to medical therapy.