Patterns and Implications of Intracranial Arterial Remodeling in Stroke Patients.
Patterns and Implications of Intracranial Arterial Remodeling in Stroke Patients.
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DOI：
10.1161/strokeaha.115.009955
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发表时间：
2016-02
期刊：
影响因子：
8.3
通讯作者：
Wasserman BA
中科院分区：
文献类型：
--
作者：
Qiao Y;Anwar Z;Intrapiromkul J;Liu L;Zeiler SR;Leigh R;Zhang Y;Guallar E;Wasserman BA
初步研究表明颅内动脉能够通过重塑来适应斑块的形成。我们试图使用 3D 高分辨率黑血 MRI (BBMRI) 研究颅内动脉重塑的能力和程度，并调查其与缺血事件的关系。 42 名患有脑血管缺血事件的患者接受了 3D 飞行时间 MRA 和 3T 对比增强 BBMRI 检查，以了解颅内动脉粥样硬化性疾病。每个斑块均按位置（例如后循环与前循环）及其引起 MRI 确定的中风的可能性（罪魁祸首、不确定或非罪魁祸首）进行分类。在病变和参考部位测量管腔面积 (LA)、外壁面积 (OWA) 和壁面积 (WA)。斑块负荷计算为 WA 除以 OWA。调整血管锥度后，动脉重塑率 (RR) 计算为病变部位的 OWA 除以参考部位的 OWA。如果 RR > 1.05，则动脉重构被分类为阳性；如果 0.95≤RR ≤ 1.05，则动脉重构被分类为中间；如果 RR <0.95，则动脉重构被分类为阴性。在 42 名患者中发现了 137 个斑块（37% [50] 位于后部，63% [87] 位于前部）。与前循环斑块相比，后循环斑块的斑块负荷更大（77.7±15.7 vs. 69.0±14.0，p=0.008），RR更高（1.14±0.38 vs. 0.95±0.32，p=0.002），且更常表现出正性重塑（54.0% vs.29.9%，p=0.011）。当根据斑块负荷进行调整时，正性重塑与下游卒中的存在略有相关（OR 1.34，95% CI：0.99-1.81）。颅内动脉因斑块形成而发生重塑，而后循环动脉具有更大的正向重塑能力，因此更有可能逃避血管造影检测。动脉重塑可以深入了解中风风险。
Preliminary studies suggest ntracranial arteries are capable of accommodating plaque formation by remodeling. We sought to study the ability and extent of intracranial arteries to remodel using 3D high-resolution black blood MRI (BBMRI) and investigate its relation to ischemic events. 42 patients with cerebrovascular ischemic events underwent 3D time-of-flight MRA and contrast-enhanced BBMRI examinations at 3T for intracranial atherosclerotic disease. Each plaque was classified by location (e.g., posterior vs. anterior circulation) and its likelihood to have caused a stroke identified on MRI (culprit, indeterminate, or non-culprit). Lumen area (LA), outer wall area (OWA), and wall area (WA) were measured at the lesion and reference sites. Plaque burden was calculated as WA divided by OWA. The arterial remodeling ratio (RR) was calculated as OWA at the lesion site divided by OWA at the reference site, after adjusting for vessel tapering. Arterial remodeling was categorized as positive if RR >1.05, intermediate if 0.95≤RR ≤ 1.05, and negative if RR <0.95. 137 plaques were identified in 42 patients (37% [50] posterior, 63% [87] anterior). Compared with anterior circulation plaques, posterior circulation plaques had a larger plaque burden (77.7±15.7 vs. 69.0±14.0, p=0.008), higher RR (1.14±0.38 vs. 0.95±0.32, p=0.002), and more often exhibited positive remodeling (54.0% vs.29.9%, p=0.011). Positive remodeling was marginally associated with downstream stroke presence when adjusted for plaque burden (OR 1.34, 95% CI: 0.99–1.81). Intracranial arteries remodel in response to plaque formation, and posterior circulation arteries have a greater capacity for positive remodeling and, consequently, may more likely elude angiographic detection. Arterial remodeling may provide insight into stroke risk.