Background and aims

The protective role of intracranial primary collaterals on plaque vulnerability is not well established. We aimed to explore the association of intracranial collateral status with arterial wall features including arterial remodeling and culprit plaque features in severe symptomatic intracranial vertebrobasilar atherosclerosis (sIVBAS).

Methods

Posterior circulation stroke or TIA patients owing to sIVBAS from a three-dimensional high-resolution MRI (3D HRMRI) prospective observational study was included for current analysis. Participants were dichotomized into poor and good collateral groups according to a modified semiquantitative grading system for primary collateral of posterior circulation. Differences of arterial remodeling, culprit plaque distribution, enhancement, intraplaque hemorrhage (IPH), and calcification on HRMRI were compared between the two groups.

Results

Seventy-four eligible patients were included, wherein 39 in poor collateral group and 35 in good collateral group. The average age was 57.0 ± 9.0 years, 65 (87.8%) were male, 62 (83.8%) were diagnosed with ischemic stroke and 12 (16.2%) with TIA. Patients with good collateral had lower occurrence of arterial positive remodeling and plaque diffuse distribution, enhancement (Adjusted OR = 0.17 [0.05–0.54], p < 0.01; adjusted OR = 0.26 [0.06–0.99], p = 0.05; adjusted OR = 0.17 [0.03–0.96], p = 0.04, respectively). No significant differences on IPH and calcification were found between poor and good collateral group (p > 0.05).

Conclusion

Intracranial good collateral of posterior circulation may be associated with lower risk of arterial positive remodeling and culprit plaque diffuse distribution, plaque enhancement in patients with severe sIVBAS.

Trial Registration

clinicaltrials.gov Identifier: NCT02705599.

中文翻译：

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严重症状性椎基底动脉狭窄的颅内侧支和动脉壁特征。

背景和目标

颅内主要侧支对斑块易损性的保护作用尚未明确。我们旨在探讨严重症状性颅内椎基底动脉粥样硬化（sIVBAS）的颅内侧支配状态与动脉壁特征（包括动脉重塑和罪犯斑块特征）的关系。

方法

当前分析包括来自三维高分辨率MRI（3D HRMRI）的sIVBAS的后循环卒中或TIA患者。根据改良的后循环主要侧支半定量分级系统，将参与者分为不良侧和良性侧支组。比较两组的动脉重塑，病变斑块分布，增强，斑块内出血（IPH）和钙化在HRMRI上的差异。

结果

纳入符合条件的患者74例，其中不良侧支组39例，良侧支组35例。平均年龄为57.0±9.0岁，其中65岁（87.8％）是男性，62岁（83.8％）被诊断为缺血性中风，TIA为12（16.2％）。侧支良好的患者发生动脉正重塑和斑块弥散分布，增强的发生率较低（校正OR = 0.17 [0.05-0.54]，p <0.01；校正OR = 0.26 [0.06-0.99]，p = 0.05；校正OR = 0.17 [0.03-0.96]，p = 0.04）。不良和不良侧支组之间在IPH和钙化方面均无显着差异（p> 0.05）。

结论

严重sIVBAS患者颅内后循环良好的侧支可能与降低动脉阳性重塑和斑块扩散分布，斑块增强的风险降低有关。

试用注册

Clinicaltrials.gov标识符：NCT02705599。