TY - JOUR
T1 - Imaging Patterns of Recurrent Infarction in the Mechanisms of Early Recurrence in Intracranial Atherosclerotic Disease (MyRIAD) Study
AU - MyRIAD Investigators
AU - Sangha, Rajbeer S.
AU - Prabhakaran, Shyam
AU - Feldmann, Edward
AU - Honda, Tristan
AU - Nizam, Azhar
AU - Cotsonis, George A.
AU - Campo-Bustillo, Iszet
AU - Romano, Jose G.
AU - Liebeskind, David S.
N1 - Funding Information:
Funding. MyRIAD was an investigator-initiated study funded by the NIH/NINDS (R01 NS084288). VasSol Inc. (River Forest, IL) provided the NOVA software for QMRA at no cost. In addition to its 10 recruiting sites, MyRIAD has various core facilities: central coordinating and TCD core (U Miami), PWI and neuroimaging core (UCLA), QMRA core (U Chicago), eligibility and endpoint adjudication (Baystate), and statistical and data management core (Emory). It was registered in ClinicalTrials.gov: NCT02121028.
Publisher Copyright:
© Copyright © 2021 Sangha, Prabhakaran, Feldmann, Honda, Nizam, Cotsonis, Campo-Bustillo, Romano and Liebeskind.
PY - 2021/1/21
Y1 - 2021/1/21
N2 - Introduction: While much is known about recurrent clinical events in patients with intracranial atherosclerotic disease (ICAD), there is limited data on characteristics of recurrent infarcts. Methods: The NIH-funded MyRIAD prospective, observational study was designed to identify mechanisms of ischemia and predictors of recurrence in ICAD. Recurrent infarction was assessed on MRI at 6–8 weeks. We reviewed the DWI/ADC and FLAIR sequences in patients with recurrent stroke and characterized the number of infarcts, infarct location, size, and patterns based on whether they were borderzone (BZ), perforator (SC/P), cortical or territorial (C/T), and mixed. Temporal characteristics were delineated by ADC/FLAIR correlation. Results: Of the 89 patients with 6–8 weeks MRI, 22 (24.7%) had recurrent infarcts in the territory of the symptomatic artery. Recurrent infarcts were evident on DWI in 63.6% and single infarcts in 54.5%. The median recurrent infarct volume was 2.0 cm3 compared to median index infarct volumes of 2.5 cm3. A mixed infarct pattern was most common (40.9%), followed by borderzone (22.7%), cortical or territorial (27.3%), while only 9.1% were in a perforator artery distribution. Amongst those with a mixed pattern, 8/9 had a borderzone distribution infarct as part of their mixed infarct pattern. Conclusion: These findings provide novel data on the characteristics of early recurrent infarcts in patients with symptomatic ICAD.
AB - Introduction: While much is known about recurrent clinical events in patients with intracranial atherosclerotic disease (ICAD), there is limited data on characteristics of recurrent infarcts. Methods: The NIH-funded MyRIAD prospective, observational study was designed to identify mechanisms of ischemia and predictors of recurrence in ICAD. Recurrent infarction was assessed on MRI at 6–8 weeks. We reviewed the DWI/ADC and FLAIR sequences in patients with recurrent stroke and characterized the number of infarcts, infarct location, size, and patterns based on whether they were borderzone (BZ), perforator (SC/P), cortical or territorial (C/T), and mixed. Temporal characteristics were delineated by ADC/FLAIR correlation. Results: Of the 89 patients with 6–8 weeks MRI, 22 (24.7%) had recurrent infarcts in the territory of the symptomatic artery. Recurrent infarcts were evident on DWI in 63.6% and single infarcts in 54.5%. The median recurrent infarct volume was 2.0 cm3 compared to median index infarct volumes of 2.5 cm3. A mixed infarct pattern was most common (40.9%), followed by borderzone (22.7%), cortical or territorial (27.3%), while only 9.1% were in a perforator artery distribution. Amongst those with a mixed pattern, 8/9 had a borderzone distribution infarct as part of their mixed infarct pattern. Conclusion: These findings provide novel data on the characteristics of early recurrent infarcts in patients with symptomatic ICAD.
KW - infarct size
KW - intracranial atherosclerosis
KW - ischemic stroke
KW - recurrent infarction pattern
KW - stroke mechanisms
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U2 - 10.3389/fneur.2020.615094
DO - 10.3389/fneur.2020.615094
M3 - Article
AN - SCOPUS:85100586136
VL - 11
JO - Frontiers in Neurology
JF - Frontiers in Neurology
SN - 1664-2295
M1 - 615094
ER -