Vulnerable Intracranial Atherosclerotic Plaques: A Morphology Study By 3-Dimensional Rotational Angiography
Refereed conference paper presented and published in conference proceedings

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AbstractBackground and Aims: Intracranial atherosclerotic disease (ICAD) is a major ischemic stroke subtype. Understanding the morphology of acute symptomatic plaques may identify vulnerable lesions and guide treatment.

Method:We performed 3-dimensional rotational angiography (3DRA) in 173 patients (median age¼60 years) within 4 weeks from an acute ischemic stroke or transient ischemic attack attributed to high-grade ICAD (>60% stenosis).We reviewed the infarct topography in DWI and FLAIR/ T2 MRI brain over the corresponding vascular territory, and investigated if plaque morphology might differ in patients with or without DWI/ FLAIR/T2 lesions.

Results: Among the 173 culprit lesions distributing in middle cerebral artery (MCA)-M1 (n¼127); intracranial internal carotid artery (ICA)- C6/7 (n¼26); across both MCA and ICA (n¼5); basilar artery (n¼13); and vertebral artery-V4 (n¼2), the median luminal stenosis over the thickest plaque region was 75%. In terms of surface lining, the plaques were smooth, irregular, or ulcerative in 51 (29.5%), 95 (54.9%), and 27 (15.6%). Ulcerative plaques were thicker (p¼0.002), more eccentric (p¼0.043), of a steeper upstream shoulder (p<0.001), and were significantly associated with adjacent branch atheromatous disease (p¼0.026) compared with smooth or irregular plaques. Patients harboring ulcerative plaques had more concurrent acute and chronic infarcts in the corresponding watershed regions than those with smooth plaques (odds ratio=5.82; p¼0.006).

Conclusion: Ulcerative plaques in cerebral arteries were associated with a higher plaque burden and vulnerable geometric features. The presence of more old-and-new infarcts with ulcerated plaques might represent
recurrent artery-to-artery thrombo-embolism.
Acceptance Date16/05/2018
All Author(s) ListT.W. Leung, C. Leng, Y. Soo, B. Ip, A. Lau, V. Mok, A. Wong, J. Abrigo, S. Yu
Name of Conference4th European Stroke Organisation Conference
Start Date of Conference16/05/2018
End Date of Conference18/05/2018
Place of ConferenceGothenburg
Country/Region of ConferenceSweden
Proceedings TitleEuropean Stroke Journal
Series TitleScientific Communications - Pathophysiology and Mechanisms
Number in SeriesAS17-008
Year2018
Month5
Volume Number3
Issue NumberSuppl 1
PublisherSAGE PUBLICATIONS LTD
Pages73 - 73
LanguagesEnglish-United Kingdom

Last updated on 2021-22-01 at 00:37