Infarct Recurrence in Intracranial Atherosclerosis: Results from the MyRIAD Study

Autor: Rajbeer S Sangha, Azhar Nizam, Edward Feldmann, Sebastian Koch, Iszet Campo-Bustillo, MyRIAD Investigators, Tatjana Rundek, David S Liebeskind, George Cotsonis, Shyam Prabhakaran, Marc I. Chimowitz, Jose G. Romano
Rok vydání: 2021
Předmět:
Male
Aging
Time Factors
Ultrasonography
Doppler
Transcranial
Hemodynamics
Cardiovascular
0302 clinical medicine
Recurrence
Risk Factors
Prospective Studies
Stroke
Ultrasonography
Plaque
Atherosclerotic
screening and diagnosis
Ischemic Attack
Transient
Cerebral infarction
Rehabilitation
Doppler
Middle Aged
Intracranial Arteriosclerosis
Prognosis
Plaque
Atherosclerotic
Detection
Intracranial Embolism
Ischemic Attack
Transient
Cerebrovascular Circulation
Cardiology
Biomedical Imaging
Female
Cardiology and Cardiovascular Medicine
4.2 Evaluation of markers and technologies
medicine.medical_specialty
ICAD
Clinical Sciences
Ischemia
Transcranial
Article
03 medical and health sciences
Clinical Research
Internal medicine
medicine
Humans
cardiovascular diseases
Aged
Ischemic Stroke
Rupture
Neurology & Neurosurgery
Rupture
Spontaneous
business.industry
Spontaneous
Prevention
Neurosciences
Atherosclerosis
medicine.disease
United States
Brain Disorders
Transcranial Doppler
Stenosis
Embolism
Surgery
Neurology (clinical)
MyRIAD Investigators
Intracranial arterial disease
business
Biomarkers
030217 neurology & neurosurgery
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, vol 30, iss 2
J Stroke Cerebrovasc Dis
ISSN: 1052-3057
Popis: Background Intracranial atherosclerotic disease (ICAD) is a common cause of ischemic stroke with a high risk of clinical stroke recurrence. Multiple mechanisms may underlie cerebral ischemia in this condition. The study's objective is to discern the mechanisms of recurrent ischemia in ICAD through imaging biomarkers of impaired antegrade flow, poor distal perfusion, abnormal vasoreactivity, and artery-to-artery embolism. Methods This prospective multicenter observational study enrolled patients with recent (≤21 days) ischemic stroke or transient ischemic attack (TIA) caused by ICAD with 50-99% stenosis treated medically. We obtained baseline quantitative MRA (QMRA), perfusion MRI (PWI), transcranial Doppler vasoreactivity (VMR), and emboli detection studies (EDS). The primary outcome was ischemic stroke in the territory of the stenotic artery within 1 year of follow-up; secondary outcomes were TIA at 1 year and new infarcts in the territory on MRI at 6-8 weeks. Results Amongst 102 of 105 participants with clinical follow-up (mean 253±131 days), the primary outcome occurred in 8.8% (12.7/100 patient-years), while 5.9% (8.5/100 patient-years) had a TIA. A new infarct in the territory of the symptomatic artery was noted in 24.7% at 6-8 weeks. A low flow state on QMRA was noted in 25.5%, poor distal perfusion on PWI in 43.5%, impaired vasoreactivity on VMR in 67.5%, and microemboli on EDS in 39.0%. No significant association was identified between these imaging biomarkers and primary or secondary outcomes. Conclusions Despite intensive medical management in ICAD, there is a high risk of clinical cerebrovascular events at 1 year and an even higher risk of new imaging-evident infarcts in the subacute period after index stroke. Hemodynamic and plaque instability biomarkers did not identify a higher risk group. Further work is needed to identify mechanisms of ischemic stroke and infarct recurrence and their consequence on long-term physical and cognitive outcomes. Trial Registration ClinicalTrials.gov: NCT02121028.
Databáze: OpenAIRE
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