Intracranial collaterals and arterial wall features in severe symptomatic vertebrobasilar stenosis

ABSTRACT

Background and aims

The protective role of intracranial primary collaterals on plaque vulnerability is not well established. We aimed to explore the association of intracranial collateral status with arterial wall features including arterial remodeling and culprit plaque features in severe symptomatic intracranial vertebrobasilar atherosclerosis (sIVBAS).

Methods

Posterior circulation stroke or TIA patients owing to sIVBAS from a three-dimensional high-resolution MRI (3D HRMRI) prospective observational study was included for current analysis. Participants were dichotomized into poor and good collateral groups according to a modified semiquantitative grading system for primary collateral of posterior circulation. Differences of arterial remodeling, culprit plaque distribution, enhancement, intraplaque hemorrhage (IPH), and calcification on HRMRI were compared between the two groups.

Results

Seventy-four eligible patients were included, wherein 39 in poor collateral group and 35 in good collateral group. The average age was 57.0 ± 9.0 years, 65 (87.8%) were male, 62 (83.8%) were diagnosed with ischemic stroke and 12 (16.2%) with TIA. Patients with good collateral had lower occurrence of arterial positive remodeling and plaque diffuse distribution, enhancement (Adjusted OR = 0.17 [0.05–0.54], p < 0.01; adjusted OR = 0.26 [0.06–0.99], p = 0.05; adjusted OR = 0.17 [0.03–0.96], p = 0.04, respectively). No significant differences on IPH and calcification were found between poor and good collateral group (p > 0.05).

Conclusion

Intracranial good collateral of posterior circulation may be associated with lower risk of arterial positive remodeling and culprit plaque diffuse distribution, plaque enhancement in patients with severe sIVBAS.

Trial Registration

clinicaltrials.gov Identifier: NCT02705599.

KEYWORDS:

• Collateral
• arterial remodeling
• vertebrobasilar artery
• high-resolution MRI

Acknowledgments

 

The authors report no acknowledgments to this manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Authors contribution

Ming Yang: study concept and design, acquisition, analysis and interpretation of data, drafting of the manuscript. Ning Ma: study concept, acquisition and interpretation of data, revision of the manuscript. Liping Liu, Jing Jing, Xin Lou, Zhikai Hou, Yifan Liu, Zhongrong Miao: acquisition of data, study supervision and coordination. Anxin Wang: analysis and interpretation of data. Yongjun Wang: study concept and design, obtaining funding, study supervision or coordination, revising the manuscript.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China [Contract grant number: 81671126 and 81730048 to X.L., 81471390 to N.M., 81371290 to Z.R.M.]; National Key R&D Program of China [Contract grant number: 2016YFC0100100 to X.L., 2017YFC1310901 to Y.J.W, 2016YFC1301501 to Z.R.M]; Beijing Municipal Science & Technology Commission [Contract grant number: D151100002015003 to Y.J.W].