Background and Purpose:Luminal imaging (degree of stenosis) currently serves as the gold standard to predict stroke recurrence and guide therapeutic strategies in patients with intracranial large artery diseases (ILADs). We comparatively evaluated the importance of vessel wall and luminal changes in predicting stroke occurrence.Methods:Consecutive patients with ILAD in the proximal middle cerebral artery or distal internal carotid artery without proximal sources of embolism from the carotid and heart underwent time-of-flight magnetic resonance angiography, high-resolution magnetic resonance imaging, and the ring finger protein 213 (RNF213) gene variant test. Patients were followed up for >3 months.Results:Of the 675 patients, 241 (35.7%) had atherosclerotic ILAD and 434 (64.3%) showed nonatherosclerotic ILAD (315 [46.7%] moyamoya disease cases and 119 [17.6%] dissection cases). The RNF213 variant was detected in 74.9%, 33.6%, and 3.4% patients with moyamoya disease, atherosclerosis, and dissection, respectively. Three hundred (44.4%) patients had asymptomatic ILAD, whereas 375 (55.6%) patients had symptomatic ILAD. Multivariate analysis showed that vessel enhancement and etiological subtypes, not degree of stenosis, determined by high-resolution magnetic resonance imaging and RNF213 gene variant analysis were independently associated with symptomatic ILAD. The presence of the RNF213 variant was also independently associated with recurrent cerebrovascular events.Conclusions:This study demonstrates the prevalence of nonatherosclerotic ILAD in East Asian patients with ILAD. Unlike luminal changes, wall changes determined by high-resolution magnetic resonance imaging and presence of the RNF213 variant could predict stroke occurrence in patients with ILADs.

中文翻译：

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颅内动脉病变的发光和壁变化，以预测中风的发生。

背景与目的：目前，影像学检查（狭窄程度）已成为预测颅内大动脉疾病（ILAD）患者中风复发和指导治疗策略的金标准。我们比较评估了血管壁和管腔变化在预测中风发生中的重要性。方法：连续性ILAD患者在近中脑中动脉或远端颈内动脉中没有近端来自颈动脉和心脏的栓塞源，接受飞行时间磁学检查共振血管造影，高分辨率磁共振成像和无名指蛋白213（RNF213）基因变异测试。结果：675例患者中有241例（35.7％）患有动脉粥样硬化性ILAD，434例（64.3％）表现为非动脉粥样硬化性ILAD（315 [46.7％]烟雾病和119例[17.6％] ）。的RNF213在74.9％，33.6％，和3.4％的患者分别烟雾病，动脉粥样硬化，和剥离，被检测的变体。300例（44.4％）患者患有无症状的ILAD，而375例（55.6％）患者患有有症状的ILAD。多变量分析显示，通过高分辨率磁共振成像和RNF213基因变异分析确定的血管增强和病因亚型而非狭窄程度与症状性ILAD独立相关。RNF213的存在结论：本研究证明了东亚ILAD患者中非动脉粥样硬化性ILAD的患病率。与管腔变化不同，通过高分辨率磁共振成像确定的壁变化和RNF213变体的存在可以预测ILAD患者中风的发生。