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Evolution of intracranial atherosclerotic disease under modern medical therapy
Author(s) -
Leung Thomas W.,
Wang Lily,
Soo Yannie O. Y.,
Ip Vincent H. L.,
Chan Anne Y. Y.,
Au Lisa W. C.,
Fan Florence S. Y.,
Lau Alex Y. L.,
Leung Howan,
Abrigo Jill,
Wong Adrian,
Mok Vincent C. T.,
Ng Ping Wing,
Tsoi Tak Hong,
Li Siu Hung,
Man Celeste B. L.,
Fong Wing Chi,
Wong Ka Sing,
Yu Simon C. H.
Publication year - 2015
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.24340
Subject(s) - medicine , interquartile range , stenosis , cardiology , transcranial doppler , stroke (engine) , odds ratio , confidence interval , radiology , mechanical engineering , engineering
Objective Understanding how symptomatic intracranial atherosclerotic disease (ICAD) evolves with current medical therapy may inform secondary stroke prevention. Methods In a prospective academic‐initiated study, we recruited 50 patients (mean age = 63.4 ± 9.0 years) with acute strokes attributed to high‐grade (≥70%) intracranial atherosclerotic stenosis for 3‐dimensional rotational angiograms before and after intensive medical therapy for 12 months. Treatment targets included low‐density lipoprotein ≤ 70mg/dl, glycosylated hemoglobin (HbA1c) ≤ 6.5%, and systolic blood pressure ≤ 140 mmHg. We analyzed infarct topography and monitored microembolic signal in recurrent strokes. The reference group was a published cohort of 143 ICAD patients. Results Overall, the stenoses regressed from 79% at baseline (interquartile range [IQR] = 71–87%) to 63% (IQR = 54–74%) in 1 year ( p < 0.001). Specifically, the qualifying lesions (n = 49) regressed (stenosis reduced >10%) in 24 patients (49%), remained quiescent (stenosis same or ±10%) in 21 patients (43%), and progressed (stenosis increased >10%) in 4 patients (8%). There was no difference in intensity of risk factor control between groups of diverging clinical or angiographic outcomes. Higher HbA1c at baseline predicted plaque regression at 1 year (odds ratio = 4.4, 95% confidence interval = 1.4–14.5, p = 0.006). Among the 6 patients with recurrent strokes pertaining to the qualifying stenosis, 5 patients had solitary or rosarylike acute infarcts along the internal or anterior border zones, and 2 patients showed microembolic signals in transcranial Doppler ultrasound. Interpretation A majority of symptomatic high‐grade intracranial plaques had regressed or remained quiescent by 12 months under intensive medical therapy. Artery‐to‐artery thromboembolism with impaired washout at border zones was a common mechanism in stroke recurrence. Ann Neurol 2015;77:478–486