Hemodynamics is associated with vessel wall remodeling in patients with middle cerebral artery stenosis

Intravascular enhancement sign at 3D T1-weighted turbo spin echo sequence is associated with cerebral atherosclerotic stenosis

OBJECTIVE

Intravascular enhancement sign (IVES) at three-dimensional T1-weighted turbo spin echo (3D T1W TSE) sequence may be a simple hemodynamic maker. This study aims to investigate the association between IVES and features of intracranial atherosclerotic stenosis (ICAS).

METHOD

Retrospective analysis of clinical and imaging data of patients who underwent high resolution-vessel wall imaging (HR-VWI) examination from May 2021 to May 2023. The number of IVES vessels and ICAS features at HR-VWI were extracted by two neuroradiologists. Paired comparisons and correlation analysis on these indicators were performed.

RESULTS

A total of 118 patients with ICAS in the first segment of the middle cerebral artery and accompanied by unilateral IVES were enrolled. Compared to the non-IVES side, a higher incidence of ischemic events and intraplaque hemorrhage (IPH), higher degree of vascular stenosis and enhancement, lower remodeling index, and lower signal intensity ratio (SIR) were found in subjects with IVES. In the ICAS with IVES, 79.66 % showed severe stenosis and occlusion; in the ICAS with severe stenosis and occlusion, 89.5 % showed IVES in the distal. A multivariable logistic regression model identified the vascular stenosis degree (OR = 1.922; 95 %CI [1.37-2.692]; P < 0.001), enhanced-degree (OR = 2.486; 95 %CI [1.315-4.698]; P = 0.005), position (OR = 2.869; 95 %CI [1.255-6.560]; P = 0.012), and SIR (OR = 0.032; 95 %CI [0.004-0.275]; P = 0.002) were independent association with the presence of IVES. The area under the curve was 0.911 for the use of IVES vessel quantities to identify severe stenosis and occlusion of arterial lumen.

CONCLUSION

The number of IVES vessels was associated with the local features of ICAS, which may indicate severe stenosis and occlusion in the major branches of the proximal artery.

Diagnostic accuracy of hemodynamic assessment of intracranial atherosclerotic stenosis from a single angiographic view: a validation study

BACKGROUND

The aim of this study is to assess the feasibility of identifying the hemodynamic status of intracranial atherosclerotic stenosis (ICAS) using angio-based fractional flow (FF) calculated from a single angiographic view, with wire-based FF as the reference standard.

METHOD

The study retrospectively recruited 100 ICAS patients who underwent pressure wire measurement and digital subtraction angiography. The AccuICAD software was used to calculate angio-based FF, with the wire-measured value serving as the reference standard for evaluating the accuracy, consistency, and diagnostic performance of angio-based FF.

RESULTS

The mean±SD value of wire-based FF was 0.77±0.18, while the mean value of angio-based FF was 0.77±0.19. A good correlation between angio-based FF and wire-based FF was evident (r=0.90, P<0.001), with good agreement (mean difference 0.00±0.08). The diagnostic accuracy of angio-based FF and percent diameter stenosis (DS%) were 93.23% versus 72.18%, 91.73% versus 72.93%, and 89.47% versus 78.95% for predicted wire-based FF thresholds of 0.70, 0.75, and 0.80, respectively. The area under the curve (AUC) values for angio-based FF and DS% were 0.975 versus 0.822, 0.970 versus 0.814, and 0.943 versus 0.826 at the respective thresholds, respectively.

CONCLUSION

The FF calculated from a single angiographic view can be considered an effective tool for functional assessment of cerebral arterial stenosis.

Association of intravascular enhancement sign on 3D-T1W TSE with collateral status in middle cerebral artery occlusion stroke

OBJECTIVE

The significance of the intravascular enhancement sign (IVES) on high-resolution magnetic resonance vascular wall imaging (HR-VWI) remains unclear. This study aimed to investigate the correlation between the IVES and collateral assessment derived from digital subtraction angiography (DSA).

METHOD

A total of 75 patients with occlusion of the first segment of the middle cerebral artery (MCA) who underwent HR-VWI and DSA examinations at our research institution between November 2016 and February 2023 were included. The number of vessels with IVES, IVES-Alberta Stroke Program Early Computed Tomography Score (ASPECTS), American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral grade, and DSA collateral blood flow grade were retrospectively evaluated. Correlations between these indicators were assessed using Spearman's correlation.

RESULTS

Interrater agreement was good for the assessment of HR-VWI and DSA indicators. After adjustments for age, degree of wall enhancement, and hypertension, a multivariable ordinal logistic regression model identified both the number of IVES vessels (OR = 1.37; 95%CI [1.06-1.78]; P = 0.017) and IVES-ASPECTS (OR = 2.00; 95%CI [1.03-3.87]; P = 0.041) as independent predictors of ischemic stroke. In the patient group with acute ischemic stroke, we found weak correlations between the number of IVES vessels and the ASITN/SIR collateral grade (rho = -0.35; P = 0.002) and between the IVES-ASPECTS and ASITN/SIR collateral grade (rho = -0.27; P = 0.02). Moreover, there were strong correlations between the number of IVES vessels and the DSA collateral blood flow grade (rho = -0.74; P < 0.001) and between the IVES-ASPECTS and the DSA collateral blood flow grade (rho = -0.65; P < 0.001). The number of IVES vessels correlated strongly with the IVES-ASPECTS (rho = 0.92, P < 0.001).

CONCLUSION

We find that the IVES is closely associated with sluggish collateral blood flow, which further confirms the hemodynamic mechanism underlying the IVES in MCA occlusion.

The diagnostic performance of high-resolution magnetic resonance-vessel wall imaging in differentiating atherosclerosis-associated moyamoya vasculopathy from moyamoya disease

OBJECTIVES

To evaluate the diagnostic performance of high-resolution magnetic resonance-vessel wall imaging (HRMR-VWI) in differentiating moyamoya disease (MMD) from atherosclerosis-associated moyamoya vasculopathy (AS-MMV) and investigate an accurate approach for the differential diagnosis.

METHODS

Adult patients who were diagnosed as MMD or AS-MMV and underwent HRMR-VWI were retrospectively included. The three vessel wall features (outer diameter (OD), remodeling index (RI), and pattern of vessel wall thickening) of middle cerebral artery (MCA) in identifying MMD from AS-MMV were assessed and compared. Furthermore, subgroup analysis stratified by degree of luminal stenosis was performed and the cutoff values of different vessel wall features in differentiating MMD from AS-MMV were also calculated.

RESULTS

A total of 265 patients (160 cases of MMD and 105 AS-MMV) were included. Patients with AS-MMV had greater OD and RI and were more likely to exhibit eccentric thickening of vessel wall compared to those with MMD (all p < 0.001). The ROC analysis showed that the AUC value of OD was greater than that of RI (0.912 vs. 0.889, p = 0.007) in differentiating MMD from AS-MMV, and their corresponding cutoff values were 1.77 mm and 0.27, respectively. And the AUC value of pattern of vessel wall thickening was 0.786 in non-occluded patients. With the increase of lumen stenosis, the discrimination power of the three indicators enhanced correspondingly.

CONCLUSIONS

HRMR-VWI is valuable in distinguishing MMD from AS-MMV. The OD of MCA has better diagnostic performance in differentiating AS-MMV from MMD compared to RI and pattern of vessel wall thickening.

CLINICAL RELEVANCE STATEMENT

The outer diameter of the involved artery proved to be both accurate and convenient in distinguishing atherosclerosis-associated moyamoya vasculopathy from moyamoya disease and may provide a quantitative reference for clinical diagnosis.

KEY POINTS

High-resolution magnetic resonance-vessel wall imaging is valuable in distinguishing atherosclerosis-associated moyamoya vasculopathy from moyamoya disease. Compared to remodeling index and pattern of vessel wall thickening, outer diameter is more accurate in differentiating atherosclerosis-associated moyamoya vasculopathy from moyamoya disease. With the increase of lumen stenosis, the discrimination power of outer diameter, remodeling index, and pattern of vessel wall thickening enhanced correspondingly.

Hemodynamics combined with inflammatory indicators exploring relationships between ischemic stroke and symptomatic middle cerebral artery atherosclerotic stenosis

BACKGROUND AND PURPOSE

Intracranial atherosclerotic stenosis (ICAS) is a major cause of ischemic stroke, and high-resolution vessel wall imaging (HR-VWI) can be used to assess the plaque characteristics of ICAS. This study combined HR-VWI, hemodynamics, and peripheral blood inflammatory indicators to investigate the role of these factors in symptomatic intracranial atherosclerotic stenosis (sICAS) and their inter-relationships.

METHODS

Patients diagnosed with atherosclerotic middle cerebral artery stenosis were recruited retrospectively from June 2018 to July 2022. Plaque enhancement was qualitatively and quantitatively analyzed, and the degree of plaque enhancement was graded according to the plaque-to-pituitary stalk contrast ratio (CR). Computational fluid dynamics models were constructed, and then hemodynamic parameters, including wall shear stress (WSS) and pressure ratio (PR), were measured and recorded. Univariate and multivariable analyses were performed to identify factors that can predict sICAS. In addition, the correlation analysis between the plaque characteristics on HR-VWI, hemodynamic parameters, and peripheral blood inflammatory indicators was performed to investigate the interrelationships between these factors.

RESULTS

Thirty-two patients were included. A higher proportion of plaque enhancement, maximum WSS, and WSS ratio (WSSR) were significantly associated with sICAS. The multiple logistic regression analysis showed that only the WSSR was an independent risk factor for sICAS. The correlation analysis revealed that both the CR and plaque burden showed linear positive correlation with the WSSR (R = 0.411, P = 0.022; R = 0.474, P = 0.007, respectively), and showed linear negative correlation with the lymphocyte to monocyte ratio (R = 0.382, P = 0.031; R = 0.716, P < 0.001, respectively).

CONCLUSIONS

The plaque enhancement and WSSR were significantly associated with sICAS, WSSR was an independent risk factor for sICAS. Plaque enhancement and plaque burden showed linear correlation with the WSSR and lymphocyte-to-monocyte ratio (LMR). Hemodynamics and inflammation combined to promote plaque progression.

Intracranial plaque characteristics on high-resolution MRI and high-sensitivity C-reactive protein levels: association and clinical relevance in acute cerebral infarction

AIM

To investigate the association between intracranial plaque characteristics and high-sensitivity C-reactive protein (hs-CRP) levels, and their combined effects on the occurrence of acute cerebral infarction (ACI).

MATERIALS AND METHODS

One hundred and forty-three patients with recent ischaemic events in the territory of middle cerebral artery or basilar artery were enrolled and divided into the ACI group (n=93) and non-ACI group (n=50) according to clinical data and diffusion-weighting imaging (DWI) results. All recruited patients underwent high-resolution magnetic resonance imaging (MRI) to assess intracranial plaque characteristics, including plaque enhancement, standardised wall index, stenosis ratio, T1 hyperintense component, remodelling pattern, plaque area, plaque burden, and maximum wall thickness. hs-CRP levels were further grouped into the low group (<1 mg/l), the intermediate group (1-3 mg/l), and the high group (≥3 mg/l). Multivariate logistic regression and receiver operating characteristic curve were constructed to evaluate the association between intracranial plaque characteristics and hs-CRP levels, as well as their synergistic effects on determining the occurrence of ACI.

RESULTS

High hs-CRP levels were associated with strong plaque enhancement (p<0.001, odds ratio [OR] = 7.497). Strong plaque enhancement (p=0.002, OR=2.109) and high hs-CRP levels (p=0.009, OR=3.893) were independently associated with the occurrence of ACI after adjustments for sex, age, and other traditional atherosclerotic risk factors. The combination of hs-CRP levels and strong plaque enhancement provided incremental information to determine ACI with an AUC of 0.823, which was significantly higher than that of strong plaque enhancement (0.711) and hs-CRP levels (0.686), respectively.

CONCLUSION

High hs-CRP levels were associated with strong plaque enhancement. The synergistic effects of hs-CRP levels and strong plaque enhancement provided incremental effects on the occurrence of ACI.

Trilobatin promotes angiogenesis after cerebral ischemia-reperfusion injury via SIRT7/VEGFA signaling pathway in rats

Angiogenesis plays a pivotal role in the recovery of neurological function after ischemia stroke. Herein, we investigated the effect of trilobatin (TLB) on angiogenesis after cerebral ischemia-reperfusion injury (CIRI). The effect of TLB on angiogenesis after CIRI were investigated in mouse brain microvascular endothelium bEnd.3 cells and middle cerebral artery occlusion (MCAO)-induced CIRI rat model. The cell proliferation and angiogenesis were observed using immunofluorescence staining. The cell cycle, expressions of cell cycle-related proteins and SIRT 1-7 were determined by flow cytometry and western blot, respectively. The binding affinity of TLB with SIRT7 was predicted by molecular docking. The results showed that TLB concentration-dependently promoted bEnd.3 cell proportion in the S-phase. TLB significantly increased the protein expressions of SIRT6, SIRT7, and VEGFA, but not affected SIRT1-SIRT5 protein expressions. Moreover, TLB not only dramatically alleviated neurological impairment after CIRI, but also enhanced post-stroke neovascularization and newly formed functional vessels in cerebral ischemic penumbra. Furthermore, TLB up-regulated the protein expressions of CDK4, cyclin D1, VEGFA and its receptor VEGFR-2. Intriguingly, TLB not only directly bound to SIRT7, but also increased SIRT7 expression at day 28. Our findings reveal that TLB promotes cerebral microvascular endothelial cells proliferation, and facilitates angiogenesis after CIRI via mediating SIRT7/VEGFA signaling pathway in rats. Therefore, TLB might be a novel restorative agent to rescue ischemia stroke.