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Panvascular Changes Under Intensive Medical Therapy in Intracranial Atherosclerotic Steno-Occlusive Disease

WeiZhuang Yuan1,2, Ming-Li Li3, Yue-Lun Zhang4

  • 1Department of Neurology, The First Affiliated Hospital Sun Yat-sen University Guangzhou China.

Journal of the American Heart Association
|July 10, 2026
PubMed

Insights

Intensive therapy for intracranial atherosclerotic disease improves artery plaque and expands meningeal lymphatics. These panvascular changes, linked to cholesterol reduction, suggest broader systemic effects beyond local plaque regression.

Area of Science:

  • Neurovascular Medicine
  • Cardiovascular Research
  • Lymphatic System Studies

Background:

  • Intensive medical therapy can improve plaque characteristics in intracranial atherosclerotic steno-occlusive disease (ICASD).
  • The comprehensive effects of this therapy on the entire intracranial arterial tree, venous pathways, and meningeal lymphatic system are not well understood.
  • This study investigates longitudinal panvascular changes in patients with ICASD undergoing intensive treatment.

Purpose of the Study:

  • To explore the longitudinal effects of intensive medical therapy on panvascular changes in patients with intracranial atherosclerotic steno-occlusive disease.
  • To assess changes in plaque burden, arterial tree morphology, venous pathways, and the meningeal lymphatic system.
  • To determine the association between low-density lipoprotein cholesterol reduction and observed vascular metric changes.

Main Methods:

  • A cohort of patients with first-ever ICASD-related stroke receiving intensive medical therapy was studied.
  • Multimodal magnetic resonance imaging was performed at baseline and 6-month follow-up.
  • Quantitative assessments included culprit artery plaque burden, lumen area, global arterial tree morphology, internal jugular vein area, and meningeal lymphatic vessel volume. Adjusted generalized additive models analyzed associations with LDL cholesterol reduction.

Main Results:

  • Significant reduction in culprit artery plaque burden was observed (-5.24%).
  • Global arterial tree length and volume increased, while mean arterial diameter decreased.
  • Meningeal lymphatic vessel volume significantly expanded (337.42 mm³), with no significant changes in internal jugular vein area. Greater LDL cholesterol reduction correlated with improved vascular metrics.

Conclusions:

  • Intensive medical therapy for ICASD induces coordinated arterial and lymphatic changes extending beyond local plaque regression.
  • These findings highlight systemic vascular remodeling and lymphatic system involvement.
  • Further research is needed to elucidate the clinical implications of these observed systemic changes.
Abstract

Keywords:
intensive medical therapyintracranial atherosclerotic steno‐occlusive diseasemeningeal lymphatic system

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