A High Resolution MRI Study of the Relationship Between Plaque Enhancement and Perforator Stroke after Stenting for Symptomatic Vertebrobasilar Artery Stenosis

https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105558Get rights and content

Abstract

Background and Purpose

Perforator stroke is one of the most common complications of vertebrobasilar arterial stenting. We investigated whether perforator stroke after vertebrobasilar arterial stenting is associated with plaque enhancement in patients with severe vertebrobasilar artery stenosis.

Methods

We studied patients with symptomatic vertebrobasilar arterial stenosis who underwent stenting from January 2017 to July 2020. Patients who underwent high resolution magnetic resonance imaging were recruited among them. Demographic data, risk factors of atherosclerosis, procedure details, and characteristics of imaging were extracted from electronic health records and imaging data. Plaque features were investigated by high resolution magnetic resonance imaging.

Results

136 patients were enrolled in this study, 39 of whom fulfilled the inclusion criteria. 18 patients (46.2%) had obvious plaque enhancement among the 39 patients, and 21 (53.8%) had plaque non-enhancement. 21 patients (53.8%) had diffuse distribution, and 22 patients (56.4%) had irregular plaques surface. Patients were divided into plaque enhanced and plaque non-enhanced groups according to the degree of plaque enhancement. Clinical characteristics and other plaque features were similar between two groups. Procedure-related perforator stroke was identified in 4 patients (10.3%). Patients with plaque enhancement were more likely to have perforator stroke after stenting compared with those with plaque non-enhancement (22.2% versus 0%, P = 0.037).

Conclusions

Plaque enhancement in high resolution magnetic resonance imaging may be associated with perforator stroke after vertebrobasilar artery stenting.

Introduction

Posterior circulation stroke (PCS) accounts for about 20% of ischemic stroke. 1 Vertebrobasilar artery (VBA) stenosis is a major cause of PCS.2,3 Patients with recently symptomatic VBA stenosis had a relatively high recurrence rate.4 Intravascular revascularization using stenting angioplasty has been performed worldwide and has achieved positive results for the treatment of VBA stenosis in recent years.5,6 With the increasing number of intracranial artery stent angioplasty, complications associated with the procedure have gradually aroused wide concern.7,8 Perforator stroke (PS) is the most common complication for patients with symptomatic intracranial atherosclerotic stenosis after endovascular angioplasty and stenting.9 The mechanisms and risk factors associated with PS after the procedure remain unexplored.

As an emerging imaging technology, high resolution magnetic resonance imaging (HRMRI) can clearly show the components of atherosclerotic plaques,10,11 which has good consistency with pathological findings.12, 13, 14, 15 Thus, HRMRI has become an ideal means to display characteristics of atherosclerotic plaques, including distribution, plaques surface and grades of enhancement.12,16, 17, 18 The enhancement of atherosclerotic plaques on HRMRI is a proven sign of reflecting the level of inflammatory activity indicating risk for disruption,19,20 and is independently associated with recent cerebrovascular ischemic events.19 PS after stent implantation may be related to plaque enhancement. However, few studies have focused on this field. In this study, we used HRMRI to investigate the relationship between plaque enhancement and PS after vertebrobasilar artery stenting.

Section snippets

Enrollment of patients

We retrospectively analyzed all patients who underwent VBA stenting from January 2017 to July 2020 in Zhongnan Hospital of Wuhan University. The inclusion criteria included: (1) patients aged from 18 to 80 years; (2) patients presented with posterior circulation stroke symptoms within 90 days; (3) patients received HRMRI within 1 week before operation; (4) ≥ 70% vertebral or basilar artery stenosis on digital subtraction angiography (DSA). Exclusion criteria included: (1) Stent placement in the

Baseline characteristics

A total of 39 patients fulfilled the inclusion criteria were included in the study, with the average age of 60.2 ± 8.9 years (ranging from 49 to 77 years), including 29 males (74.4%). All the patients had ≥ 1 risk factor(s) of atherosclerosis, and 12 patients (30.8%) had 3 or more risk factors of atherosclerosis. The most common risk factors were hypertension (82.1%), smoking (59.0%), diabetes (38.5%), and hyperlipidemia (25.6%). The lesions were located at the vertebral artery in 21 patients

Discussion

Unlike the anterior circulation, a definite treatment strategy for symptomatic large artery stenosis of the posterior circulation has not yet been established.23 Studies have shown that artery stenosis caused by atherosclerotic plaque was a reliable predictor of ischemic stroke, and the degree of stenosis greater than 50% was considered to be a risk factor of ischemic stroke.24 At present, the implementation of the arterial stent is mainly based on the degree of vascular stenosis. Although

Conflict of Interest

All authors have no conflicts of interest to report.

Role of the funding source

This research was funded by the Applied Basic Research Project of Wuhan (number 2017060201010167).

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    • Cited by (0)

    1

    Xuanzhen Lu and Cuicui Li contributed equally to this work.

    2

    Yumin Liu and Haibo Xu are co-corresponding authors.

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