Plaque Steepness is Associated with Hemodynamics in Patients with Atherosclerotic Middle Cerebral Artery Stenosis
Mi Wang1, Bin Jiang2, Danfeng Zhang1
1Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
Insights
Steepness of atherosclerotic plaques in the middle cerebral artery (MCA) is linked to altered hemodynamics. Steeper plaques are associated with a higher risk of stroke.
Area of Science:
- Neurology
- Cardiovascular Imaging
- Biomedical Engineering
Background:
- Atherosclerotic stenosis in the middle cerebral artery (MCA) poses a significant stroke risk.
- Understanding plaque morphology and its hemodynamic impact is crucial for risk stratification.
Purpose of the Study:
- To investigate the relationship between plaque steepness and hemodynamic parameters in MCA stenosis.
- To correlate plaque characteristics with indicators of plaque vulnerability.
Main Methods:
- Eighty patients with unilateral MCA stenosis (50%-99%) underwent high-resolution MRI.
- Computational fluid dynamics (CFD) was used to assess wall shear stress ratio (WSSR) and wall shear stress in stenosis (WSSs).
- Plaque dimensions, vessel wall features, and DWI status were analyzed and correlated with hemodynamic parameters.
Main Results:
- The DWI-positive group exhibited smaller lumen area, larger plaque area, and higher WSSR and WSSs.
- Plaque height and its ratio to width were significantly larger in the DWI-positive group.
- Plaque height and height/width ratio strongly correlated with WSSR (r=0.805 and r=0.879, respectively).
Conclusions:
- Plaque steepness, characterized by height and height/width ratio, is a significant feature in MCA stenosis.
- Steeper atherosclerotic plaques are associated with adverse hemodynamic changes and may indicate increased stroke risk.
Objective:
To evaluate the relationship between plaque steepness and hemodynamics in middle cerebral artery (MCA) stenosis based on high-resolution magnetic resonance imaging and computational fluid dynamics.
Methods:
Eighty consecutive patients accompanying with unilateral atherosclerotic MCA stenosis (50%-99%) were prospectively recruited. All patients underwent a cross-sectional scan of the stenotic MCA vessel wall. The parameters and features of the plaque, vessel wall, translesional wall shear stress ratio (WSSR), wall shear stress in stenosis (WSSs), and translesional pressure ratio (RP) were obtained. The patients were divided into the DWI-positive group and the DWI-negative group. The differences in plaque, vessel wall, and hemodynamics were compared between the two groups. Correlations between the plaque steepness and hemodynamics were calculated.
Results:
The DWI-positive group (31 cases) had a smaller lumen area (LA) (P = 0.024), larger plaque area (PA) (P < 0.001) and normal wall index (NWI) (P = 0.009), higher WSSR (P = 0.009) and WSSs (P = 0.018), and larger plaques' height (P = 0.039) and radio of height/width (P = 0.014) at the most stenotic site. The DWI-positive group had more enhanced plaques (24 vs 13, P = 0.03), positive remodeling patients (23 vs 20, P < 0.001) than the DWI-negative group (49 cases). The height of plaque (r = 0.805, P < 0.001) and ratio of height/width (r = 0.879, P < 0.001) showed positive correlation with WSSR, respectively.
Conclusion:
Steepness is an important feature of atherosclerotic plaques; individuals with steep plaques might be more prone to stroke.
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