Small-vessel vasculopathy harboured within intracranial large-artery atherosclerosis
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AbstractObjective: To study the co-existence of small-vessel vasculopathy in subordinate branches emanating from high-grade intracranial large-artery atherosclerosisBackground: Intracranial atherosclerotic disease (ICAD) is globally a major ischemic stroke subtype. Understanding the stroke mechanism of lacunar syndrome in ICAD and her susceptibility to perforator stroke during stenting may inform treatment strategy.Design/Methods: Patients with acute ischemic stroke attributed to high-grade (60–99%) middle cerebral artery (MCA) or basilar artery (BA) stenosis underwent 3-dimensional rotational angiography (3DRA) to delineate the patency of subordinate branches emanating immediately from the stenotic segments. For MCA stenoses, we scrutinised lenticulostriate artery, anterior temporal artery, and occasionally, an early M2 branch from a horizontal M1 segment. For BA lesions, we examined superior cerebellar artery and anterior inferior cerebellar artery.We diagnosed branch atheromatous disease (BAD) if an ostial atheroma occluded >50% the orifice of a subordinate branch/perforator. BAD could be ‘adjoining BAD’ if the junctional atheroma was contiguous and morphologically inseparable from the main bulk of the parent plaque; or ‘isolated BAD’ if the orifical atheroma was discrete from the parent plaques.We diagnosed intrinsic small-vessel vasculopathy if the steno-occlusion was distinctively distal to a normal orifice.Results: Among the 146 patients harbouring MCA (n=132) or BA plaques (n=14), the median luminal stenosis was 75%. 101 patients (69%) had steno-occlusions further in the penetrating arteries/subordinate branches within these high-grade ICAD segments. By anatomic location, these small-vessel steno-occlusions (n=107) were primarily orifical (due to adjoining BAD (n=88) or isolated ostial atheroma (n=6)). Distal intrinsic vasculopathy was much less common (n=13).Conclusions: Concurrent small-vessel vasculopathy was frequent in ICAD, and the predominance of orifical obstructive atheroma accounted for common occurrence of lacunar syndrome in ICAD and the risk of perforator jailing or occlusion during stenting in this subgroup.Disclosure: Dr. Leung has nothing to disclose. Dr. Leng has nothing to disclose. Dr. Soo has nothing to disclose. Dr. Ip has nothing to disclose. Dr. Sze Ho has nothing to disclose. Dr. Ip has nothing to disclose. Dr. Yu has nothing to disclose.
All Author(s) ListLeung TW, Leng X, Soo Y, Ip V, Ma SH, Ip B, Yu S
Name of ConferenceThe 2020 American Academy of Neurology Annual Meeting
Start Date of Conference25/04/2020
End Date of Conference01/05/2020
Place of ConferenceToronto
Country/Region of ConferenceCanada
Proceedings TitleNeurology
Volume Number94
Issue NumberSuppl. 15
Article number1123
LanguagesEnglish-United States

Last updated on 2022-15-01 at 00:26