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- Title
Hemodynamics and stroke risk in intracranial atherosclerotic disease.
- Authors
Leng, Xinyi; Lan, Linfang; Ip, Hing Lung; Abrigo, Jill; Scalzo, Fabien; Liu, Haipeng; Feng, Xueyan; Chan, Ka Lung; Fan, Florence S. Y.; Ma, Sze Ho; Fang, Hui; Xu, Yuming; Li, Jingwei; Zhang, Bing; Xu, Yun; Soo, Yannie O. Y.; Mok, Vincent C. T.; Yu, Simon C. H.; Liebeskind, David S.; Wong, Ka Sing
- Abstract
<bold>Objective: </bold>To investigate whether hemodynamic features of symptomatic intracranial atherosclerotic stenosis (sICAS) might correlate with the risk of stroke relapse, using a computational fluid dynamics (CFD) model.<bold>Methods: </bold>In a cohort study, we recruited patients with acute ischemic stroke attributed to 50 to 99% ICAS confirmed by computed tomographic angiography (CTA). With CTA-based CFD models, translesional pressure ratio (PR = pressurepoststenotic /pressureprestenotic ) and translesional wall shear stress ratio (WSSR = WSSstenotic - throat /WSSprestenotic ) were obtained in each sICAS lesion. Translesional PR ≤ median was defined as low PR and WSSR ≥4th quartile as high WSSR. All patients received standard medical treatment. The primary outcome was recurrent ischemic stroke in the same territory (SIT) within 1 year.<bold>Results: </bold>Overall, 245 patients (median age = 61 years, 63.7% males) were analyzed. Median translesional PR was 0.94 (interquartile range [IQR] = 0.87-0.97); median translesional WSSR was 13.3 (IQR = 7.0-26.7). SIT occurred in 20 (8.2%) patients, mostly with multiple infarcts in the border zone and/or cortical regions. In multivariate Cox regression, low PR (adjusted hazard ratio [HR] = 3.16, p = 0.026) and high WSSR (adjusted HR = 3.05, p = 0.014) were independently associated with SIT. Patients with both low PR and high WSSR had significantly higher risk of SIT than those with normal PR and WSSR (risk = 17.5% vs 3.0%, adjusted HR = 7.52, p = 0.004).<bold>Interpretation: </bold>This work represents a step forward in utilizing computational flow simulation techniques in studying intracranial atherosclerotic disease. It reveals a hemodynamic pattern of sICAS that is more prone to stroke relapse, and supports hypoperfusion and artery-to-artery embolism as common mechanisms of ischemic stroke in such patients. Ann Neurol 2019;85:752-764.
- Subjects
STROKE; HEMODYNAMICS; STROKE patients; DISEASE risk factors; ATHEROSCLEROSIS; INTRACRANIAL arterial diseases; ARTERIAL stenosis; DISEASE relapse
- Publication
Annals of Neurology, 2019, Vol 85, Issue 5, p752
- ISSN
0364-5134
- Publication type
journal article
- DOI
10.1002/ana.25456