TY - JOUR
T1 - Intracranial dolichoectasia in patients with symptomatic intracranial atherosclerotic disease
T2 - Results from the MYRIAD study
AU - of the MYRIAD Investigators
AU - Del Brutto, Victor J.
AU - Prabhakaran, Shyam
AU - Liebeskind, David S.
AU - Campo-Bustillo, Iszet
AU - Cotsonis, George
AU - Nizam, Azhar
AU - Romano, Jose G.
N1 - Funding Information:
MYRIAD study was funded by NIH/NINDS (R01 NS084288); V.J. Del Brutto has salary support from the Florida Regional Coordinating Center for the NINDS Stroke Trials Network; S. Prabhakaran has research salary support for role as PI (MPI) of MYRIAD from NIH/NINDS (1R01NS084288). Receives compensation from AHRQ/NIH grants, Abbvie consulting, and UpToDate royalties; D.S. Liebeskind has research salary support for role as PI (MPI) of MYRIAD from NIH/NINDS (1R01NS084288); I. Campo‐Bustillo has salary support from R01 grant NIH/NINDS (1R01NS084288) to the University of Miami for role as MyRIAD Project Manager; G. Cotsonis has research salary support for role as biostatistician of MYRIAD from NIH/NINDS (1R01NS084288); A. Nizam has research salary support for role as biostatistician of MYRIAD from NIH/NINDS (1R01NS084288); J.G. Romano has research salary support for role as PI (MPI) of MYRIAD from NIH/NINDS (1R01NS084288).
Publisher Copyright:
© 2021 American Society of Neuroimaging
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Background and Purpose: It is unknown whether intracranial atherosclerotic disease (ICAD), in addition to causing stenosis, also associates with abnormal arterial enlargement, a condition known as intracranial dolichoectasia (IDE). Across symptomatic ICAD patients, we aim to determine IDE prevalence and IDE impact on cerebral hemodynamics and recurrent cerebral ischemia. Methods: We analyzed 98 participants (mean age 63.8 (Formula presented.) 11.9 years, 56.1% men) of the prospective observational study MYRIAD. Participants were enrolled within 21 days of an ischemic stroke or transient ischemic attack caused by moderate-to-severe ICAD. Semi-automatic vessel segmentation was used to determine diameters, length, and tortuosity-index of proximal intracranial arteries. Either ectasia (increased diameter) or dolichosis (increased length or TI) defined IDE. We assessed IDE association with new infarcts during 12-month follow-up, and IDE correlation with cerebral hemodynamics determined by quantitative MR-angiography (QMRA), MR-perfusion weighted-imaging, and transcranial Doppler breath-holding index. Results: IDE was present in 35.7% of patients and 10.2% of symptomatic arteries. Basilar stenosis was associated with higher IDE prevalence (27.8% vs. 8.8%, p = 0.04), whereas other symptomatic arteries showed no association with IDE. Symptomatic arteries with IDE had lower hypoperfusion prevalence on MR-PWI (11.1% vs. 28.4%, p = 0.03). Increased diameter (r = 0.33, p<0.01) and tortuosity-index (r = 0.29, p = 0.01) showed positive correlation with QMRA flow rate. IDE was not associated with new infarcts during follow-up. Conclusions: IDE was common among symptomatic ICAD patients. IDE was not associated with stroke recurrence. Instead, increased diameter and tortuosity correlated with improved blood flow across the stenotic artery, suggesting that IDE may originate as an adaptive mechanism in ICAD.
AB - Background and Purpose: It is unknown whether intracranial atherosclerotic disease (ICAD), in addition to causing stenosis, also associates with abnormal arterial enlargement, a condition known as intracranial dolichoectasia (IDE). Across symptomatic ICAD patients, we aim to determine IDE prevalence and IDE impact on cerebral hemodynamics and recurrent cerebral ischemia. Methods: We analyzed 98 participants (mean age 63.8 (Formula presented.) 11.9 years, 56.1% men) of the prospective observational study MYRIAD. Participants were enrolled within 21 days of an ischemic stroke or transient ischemic attack caused by moderate-to-severe ICAD. Semi-automatic vessel segmentation was used to determine diameters, length, and tortuosity-index of proximal intracranial arteries. Either ectasia (increased diameter) or dolichosis (increased length or TI) defined IDE. We assessed IDE association with new infarcts during 12-month follow-up, and IDE correlation with cerebral hemodynamics determined by quantitative MR-angiography (QMRA), MR-perfusion weighted-imaging, and transcranial Doppler breath-holding index. Results: IDE was present in 35.7% of patients and 10.2% of symptomatic arteries. Basilar stenosis was associated with higher IDE prevalence (27.8% vs. 8.8%, p = 0.04), whereas other symptomatic arteries showed no association with IDE. Symptomatic arteries with IDE had lower hypoperfusion prevalence on MR-PWI (11.1% vs. 28.4%, p = 0.03). Increased diameter (r = 0.33, p<0.01) and tortuosity-index (r = 0.29, p = 0.01) showed positive correlation with QMRA flow rate. IDE was not associated with new infarcts during follow-up. Conclusions: IDE was common among symptomatic ICAD patients. IDE was not associated with stroke recurrence. Instead, increased diameter and tortuosity correlated with improved blood flow across the stenotic artery, suggesting that IDE may originate as an adaptive mechanism in ICAD.
KW - atherosclerosis
KW - atherosclerotic disease
KW - dilatative arteriopathy
KW - dolichoectasia
KW - intracranial
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U2 - 10.1111/jon.12872
DO - 10.1111/jon.12872
M3 - Article
AN - SCOPUS:85105818619
VL - 31
SP - 931
EP - 939
JO - Journal of Neuroimaging
JF - Journal of Neuroimaging
SN - 1051-2284
IS - 5
ER -