RT Journal Article
SR Electronic
T1 Plaque morphology in acute symptomatic intracranial atherosclerotic disease
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 370
OP 376
DO 10.1136/jnnp-2020-325027
VO 92
IS 4
A1 Thomas W Leung
A1 Li Wang
A1 Xinying Zou
A1 Yannie Soo
A1 Yuehua Pu
A1 Hing Lung Ip
A1 Anne Chan
A1 Lisa Wing Chi Au
A1 Florence Fan
A1 Sze Ho Ma
A1 Bonaventure Ip
A1 Karen Ma
A1 Alexander Yuk-lun Lau
A1 Howan Leung
A1 Kwok Fai Hui
A1 Richard Li
A1 Siu Hung Li
A1 Michael Fu
A1 Wing Chi Fong
A1 Jia Liu
A1 Vincent Mok
A1 Ka Sing Lawrence Wong
A1 Zhongrong Miao
A1 Ning Ma
A1 Simon C H Yu
A1 Xinyi Leng
YR 2021
UL http://jnnp.bmj.com/content/92/4/370.abstract
AB Background Intracranial atherosclerotic disease (ICAD) is globally a major ischaemic stroke subtype with high recurrence. Understanding the morphology of symptomatic ICAD plaques, largely unknown by far, may help identify vulnerable lesions prone to relapse.Methods We prospectively recruited patients with acute ischaemic stroke or transient ischaemic attack attributed to high-grade ICAD (60%–99% stenosis). Plaque morphological parameters were assessed in three-dimensional rotational angiography, including surface contour, luminal stenosis, plaque length/thickness, upstream shoulder angulation, axial/longitudinal plaque distribution and presence of adjoining branch atheromatous disease (BAD). We compared morphological features of smooth, irregular and ulcerative plaques and correlated them with cerebral ischaemic lesion load downstream in MRI.Results Among 180 recruited patients (median age=60 years; 63.3% male; median stenosis=75%), plaque contour was smooth (51 (28.3%)), irregular (101 (56.1%)) or ulcerative (28 (15.6%)). Surface ulcers were mostly at proximal (46.4%) and middle one-third (35.7%) of the lesions. Most (84.4%) plaques were eccentric, and half had their maximum thickness over the distal end. Ulcerative lesions were thicker (medians 1.6 vs 1.3 mm; p=0.003), had steeper upstream shoulder angulation (56.2° vs 31.0°; p<0.001) and more adjoining BAD (83.3% vs 57.0%; p=0.033) than non-ulcerative plaques. Ulcerative plaques were significantly associated with coexisting acute and chronic infarcts downstream (35.7% vs 12.5%; adjusted OR 4.29, 95% CI 1.65 to 11.14, p=0.003). Sensitivity analyses in patients with anterior-circulation ICAD lesions showed similar results in the associations between the plaque types and infarct load.Conclusions Ulcerative intracranial atherosclerotic plaques were associated with vulnerable morphological features and had a higher cumulative infarct load downstream.