Mechanisms of early Recurrence in Intracranial Atherosclerotic Disease (MyRIAD): Rationale and design

David S. Liebeskind, Shyam Prabhakaran, Nizam Azhar, Edward Feldmann, Iszet Campo-Bustillo, Rajbeer Sangha, Sebastian Koch, Tatjana Rundek, Lauren Ostergren, Marc I. Chimowitz, Jose G. Romano

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Rationale: Intracranial atherosclerotic disease (ICAD) is the most common cause of ischemic stroke with the highest rate of recurrence, despite aggressive medical management. Diverse mechanisms may be responsible for ICAD-related cerebral ischemia, with potential therapeutic implications. Here we present the rationale, design and methods of the Mechanisms of Early Recurrence in Intracranial Atherosclerotic Disease (MyRIAD) study. The aim of MyRIAD is to determine the mechanisms of stroke in ICAD through physiologic imaging biomarkers that evaluate impaired antegrade flow, poor distal perfusion, abnormal vasoreactivity, artery to artery embolism, and their interaction. Methods and design: This is a prospective observational study of patients with recently symptomatic (<21 days) ICAD with 50–99% stenosis treated medically and monitored for up to 1 year. An estimated 110 participants are recruited at 10 sites to identify the association between the presence of each mechanism of ischemia and recurrent stroke. The primary outcome is ischemic stroke in the territory of the symptomatic artery. Secondary outcomes include new cerebral infarction on MRI at 6–8 weeks and recurrent TIA in the territory of the symptomatic artery. Discussion: MyRIAD is positioned to define the role of specific mechanisms of recurrent ischemia in patients with symptomatic ICAD. This knowledge will allow the development and implementation of effective and specific treatments for this condition.

Original languageEnglish (US)
Article number105051
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number10
StatePublished - Oct 2020


  • Biomarkers
  • Intracranial arterial disease
  • Research design
  • Stroke

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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