BACKGROUND Intracranial atherosclerosis,a leading cause of stroke,involves arterial plaque formation.This study explores the link between plaque remodelling patterns and diabetes using high-resolution vessel wall imag...BACKGROUND Intracranial atherosclerosis,a leading cause of stroke,involves arterial plaque formation.This study explores the link between plaque remodelling patterns and diabetes using high-resolution vessel wall imaging(HR-VWI).AIM To investigate the factors of intracranial atherosclerotic remodelling patterns and the relationship between intracranial atherosclerotic remodelling and diabetes mellitus using HR-VWI.METHODS Ninety-four patients diagnosed with middle cerebral artery or basilar artery INTRODUCTION Intracranial atherosclerotic disease is one of the main causes of ischaemic stroke in the world,accounting for approx-imately 10%of transient ischaemic attacks and 30%-50%of ischaemic strokes[1].It is the most common factor among Asian people[2].The adaptive changes in the structure and function of blood vessels that can adapt to changes in the internal and external environment are called vascular remodelling,which is a common and important pathological mechanism in atherosclerotic diseases,and the remodelling mode of atherosclerotic plaques is closely related to the occurrence of stroke.Positive remodelling(PR)is an outwards compensatory remodelling where the arterial wall grows outwards in an attempt to maintain a constant lumen diameter.For a long time,it was believed that the degree of stenosis can accurately reflect the risk of ischaemic stroke[3-5].Previous studies have revealed that lesions without significant luminal stenosis can also lead to acute events[6,7],as summarized in a recent meta-analysis study in which approximately 50%of acute/subacute ischaemic events were due to this type of lesion[6].Research[8,9]has pointed out that the PR of plaques is more dangerous and more likely to cause acute ischaemic stroke.Previous studies[10-13]have found that there are specific vascular remodelling phenomena in the coronary and carotid arteries of diabetic patients.However,due to the deep location and small lumen of intracranial arteries and limitations of imaging techniques,the relationship between intracranial arterial remodelling and diabetes is still unclear.In recent years,with the development of magnetic resonance technology and the emergence of high-resolution(HR)vascular wall imaging,a clear and multidimensional display of the intracranial vascular wall has been achieved.Therefore,in this study,HR wall imaging(HR-VWI)was used to display the remodelling characteristics of bilateral middle cerebral arteries and basilar arteries and to explore the factors of intracranial vascular remodelling and its relationship with diabetes.展开更多
In vivo studies on association between wall shear stress(WSS)and intracranial plaque are deficient.Based on the three-dimensional T1-weighted high-resolution magnetic resonance imaging(3DT1 HR-MRI)data of patients wit...In vivo studies on association between wall shear stress(WSS)and intracranial plaque are deficient.Based on the three-dimensional T1-weighted high-resolution magnetic resonance imaging(3DT1 HR-MRI)data of patients with low-grade stenotic(<50%)atherosclerotic middle cerebral artery(MCA)and subjects with normal MCA,we built a three-dimensional reconstructed WSS model by computational fluid dynamics(CFD)technique.Three-dimensional registration of the CFD model to the HR-MRI was performed with projections based on the resolution and thickness of the images.The relationships between the Wss at each side of the vessel wall and plaque location were analyzed.A total of 94 MCA plaques from 43 patients and 50 normal MCAs were analyzed.In the normal MCAs,WSS was lower at the ventral-inferior wall than at the dorsal-superior wall(proximal segment,p<0.001;middle segment,p<0.001)and lower at the inner wall than at the outer wall of the MCA curve(p<0.001).In atherosclerotic MCAs,similar low Wss regions were observed where plaques developed.The WSS ratio of the ventral-inferior wall to the dorsal-superior wall in atherosclerotic MCAs was lower than that in normal MCAs(p=0.002).The WSS_(inmer-outer)ratio in atherosclerotic MCAs was lower than that in normal MCAs(p=0.002).Low WSS was associated with MCA atherosclerosis formation and occurred mainly at the ventral inferior wall,which was anatomically opposite the orifices of penetrating arteries,and at the inner wall of the MCA curve.Overall,the results were well consistent with the low WSS theory in atherosclerosis formation.The reconstructed WSS model is a promising novel method for assessing an individualized vascular profile once validated by further studies.展开更多
Background:The effect of arteriosclerotic intracranial arterial vessel wall enhancement(IAVWE)on downstream collateral flow found in vessel wall imaging(VWI)is not clear.Regardless of the mechanism underlying IAVWE on...Background:The effect of arteriosclerotic intracranial arterial vessel wall enhancement(IAVWE)on downstream collateral flow found in vessel wall imaging(VWI)is not clear.Regardless of the mechanism underlying IAVWE on VWI,damage to the patient’s nervous system caused by IAVWE is likely achieved by affecting downstream cerebral blood flow.The present study aimed to investigate the effect of arteriosclerotic IAVWE on downstream collateral flow.Methods:The present study recruited 63 consecutive patients at the Second Hospital of Hebei Medical University from January 2021 to November 2021 with underlying atherosclerotic diseases and unilateral middle cerebral artery(MCA)M1-segment stenosis who underwent an magnetic resonance scan within 3 days of symptom onset.The patients were divided into 4 groups according to IAVWE and the stenosis ratio(Group 1,n=17;Group 2,n=19;Group 3,n=13;Group 4,n=14),and downstream collateral flow was analyzed using three-dimensional pseudocontinuous arterial spin labeling(3D-pCASL)and RAPID software.The National Institutes of Health Stroke Scale(NIHSS)scores of the patients were also recorded.Two-factor multivariate analysis of variance using Pillai’s trace was used as the main statistical method.Results:No statistically significant difference was found in baseline demographic characteristics among the groups.IAVWE,but not the stenosis ratio,had a statistically significant significance on the late-arriving retrograde flow proportion(LARFP),hypoperfusion intensity ratio(HIR),and NIHSS scores(F=20.941,P<0.001,Pillai’s trace statistic=0.567).The between-subject effects test showed that IAVWE had a significant effect on the three dependent variables:LARFP(R^(2)=0.088,F=10.899,P=0.002),HIR(R^(2)=0.234,F=29.354,P<0.001),and NIHSS(R^(2)=114.339,F=33.338,P<0.001).Conclusions:Arteriosclerotic IAVWE significantly reduced downstream collateral flow and affected relevant neurological deficits.It was an independent factor affecting downstream collateral flow and NIHSS scores,which should be a focus of future studies.Trial Registration:ChiCTR.org.cn,ChiCTR2100053661.展开更多
基金Supported by National Natural Science Foundation of China,No.82071871Guangdong Basic and Applied Basic Research Foundation,No.2021A1515220131+1 种基金Guangdong Medical Science and Technology Research Fund Project,No.2022111520491834Clinical Research Project of Shenzhen Second People's Hospital,No.20223357022。
文摘BACKGROUND Intracranial atherosclerosis,a leading cause of stroke,involves arterial plaque formation.This study explores the link between plaque remodelling patterns and diabetes using high-resolution vessel wall imaging(HR-VWI).AIM To investigate the factors of intracranial atherosclerotic remodelling patterns and the relationship between intracranial atherosclerotic remodelling and diabetes mellitus using HR-VWI.METHODS Ninety-four patients diagnosed with middle cerebral artery or basilar artery INTRODUCTION Intracranial atherosclerotic disease is one of the main causes of ischaemic stroke in the world,accounting for approx-imately 10%of transient ischaemic attacks and 30%-50%of ischaemic strokes[1].It is the most common factor among Asian people[2].The adaptive changes in the structure and function of blood vessels that can adapt to changes in the internal and external environment are called vascular remodelling,which is a common and important pathological mechanism in atherosclerotic diseases,and the remodelling mode of atherosclerotic plaques is closely related to the occurrence of stroke.Positive remodelling(PR)is an outwards compensatory remodelling where the arterial wall grows outwards in an attempt to maintain a constant lumen diameter.For a long time,it was believed that the degree of stenosis can accurately reflect the risk of ischaemic stroke[3-5].Previous studies have revealed that lesions without significant luminal stenosis can also lead to acute events[6,7],as summarized in a recent meta-analysis study in which approximately 50%of acute/subacute ischaemic events were due to this type of lesion[6].Research[8,9]has pointed out that the PR of plaques is more dangerous and more likely to cause acute ischaemic stroke.Previous studies[10-13]have found that there are specific vascular remodelling phenomena in the coronary and carotid arteries of diabetic patients.However,due to the deep location and small lumen of intracranial arteries and limitations of imaging techniques,the relationship between intracranial arterial remodelling and diabetes is still unclear.In recent years,with the development of magnetic resonance technology and the emergence of high-resolution(HR)vascular wall imaging,a clear and multidimensional display of the intracranial vascular wall has been achieved.Therefore,in this study,HR wall imaging(HR-VWI)was used to display the remodelling characteristics of bilateral middle cerebral arteries and basilar arteries and to explore the factors of intracranial vascular remodelling and its relationship with diabetes.
基金This work was supported by the National Science Fund for Distinguished Young Scholars(Grant No.8202500477)the National Natural Science Foundation of China(Grants No.81471207,81671370,81661168015)2016 PUMCH science fund for junior faculty,and Shenzhen Science and Technology Innovation Commission(Grant No.JCYJ20160608153506088).
文摘In vivo studies on association between wall shear stress(WSS)and intracranial plaque are deficient.Based on the three-dimensional T1-weighted high-resolution magnetic resonance imaging(3DT1 HR-MRI)data of patients with low-grade stenotic(<50%)atherosclerotic middle cerebral artery(MCA)and subjects with normal MCA,we built a three-dimensional reconstructed WSS model by computational fluid dynamics(CFD)technique.Three-dimensional registration of the CFD model to the HR-MRI was performed with projections based on the resolution and thickness of the images.The relationships between the Wss at each side of the vessel wall and plaque location were analyzed.A total of 94 MCA plaques from 43 patients and 50 normal MCAs were analyzed.In the normal MCAs,WSS was lower at the ventral-inferior wall than at the dorsal-superior wall(proximal segment,p<0.001;middle segment,p<0.001)and lower at the inner wall than at the outer wall of the MCA curve(p<0.001).In atherosclerotic MCAs,similar low Wss regions were observed where plaques developed.The WSS ratio of the ventral-inferior wall to the dorsal-superior wall in atherosclerotic MCAs was lower than that in normal MCAs(p=0.002).The WSS_(inmer-outer)ratio in atherosclerotic MCAs was lower than that in normal MCAs(p=0.002).Low WSS was associated with MCA atherosclerosis formation and occurred mainly at the ventral inferior wall,which was anatomically opposite the orifices of penetrating arteries,and at the inner wall of the MCA curve.Overall,the results were well consistent with the low WSS theory in atherosclerosis formation.The reconstructed WSS model is a promising novel method for assessing an individualized vascular profile once validated by further studies.
基金Beijing Scholar 2015(No.2015-160)Health Commission of Hebei Province(No.20200919)Scientific Research Fund Project of the Second Hospital of Hebei Medical University(No.2HC202056)
文摘Background:The effect of arteriosclerotic intracranial arterial vessel wall enhancement(IAVWE)on downstream collateral flow found in vessel wall imaging(VWI)is not clear.Regardless of the mechanism underlying IAVWE on VWI,damage to the patient’s nervous system caused by IAVWE is likely achieved by affecting downstream cerebral blood flow.The present study aimed to investigate the effect of arteriosclerotic IAVWE on downstream collateral flow.Methods:The present study recruited 63 consecutive patients at the Second Hospital of Hebei Medical University from January 2021 to November 2021 with underlying atherosclerotic diseases and unilateral middle cerebral artery(MCA)M1-segment stenosis who underwent an magnetic resonance scan within 3 days of symptom onset.The patients were divided into 4 groups according to IAVWE and the stenosis ratio(Group 1,n=17;Group 2,n=19;Group 3,n=13;Group 4,n=14),and downstream collateral flow was analyzed using three-dimensional pseudocontinuous arterial spin labeling(3D-pCASL)and RAPID software.The National Institutes of Health Stroke Scale(NIHSS)scores of the patients were also recorded.Two-factor multivariate analysis of variance using Pillai’s trace was used as the main statistical method.Results:No statistically significant difference was found in baseline demographic characteristics among the groups.IAVWE,but not the stenosis ratio,had a statistically significant significance on the late-arriving retrograde flow proportion(LARFP),hypoperfusion intensity ratio(HIR),and NIHSS scores(F=20.941,P<0.001,Pillai’s trace statistic=0.567).The between-subject effects test showed that IAVWE had a significant effect on the three dependent variables:LARFP(R^(2)=0.088,F=10.899,P=0.002),HIR(R^(2)=0.234,F=29.354,P<0.001),and NIHSS(R^(2)=114.339,F=33.338,P<0.001).Conclusions:Arteriosclerotic IAVWE significantly reduced downstream collateral flow and affected relevant neurological deficits.It was an independent factor affecting downstream collateral flow and NIHSS scores,which should be a focus of future studies.Trial Registration:ChiCTR.org.cn,ChiCTR2100053661.
