PMID- 30840312
OWN - NLM
STAT- MEDLINE
DCOM- 20200213
LR  - 20200213
IS  - 1531-8249 (Electronic)
IS  - 0364-5134 (Linking)
VI  - 85
IP  - 5
DP  - 2019 May
TI  - Hemodynamics and stroke risk in intracranial atherosclerotic disease.
PG  - 752-764
LID - 10.1002/ana.25456 [doi]
AB  - OBJECTIVE: To investigate whether hemodynamic features of symptomatic 
      intracranial atherosclerotic stenosis (sICAS) might correlate with the risk of 
      stroke relapse, using a computational fluid dynamics (CFD) model. METHODS: In a 
      cohort study, we recruited patients with acute ischemic stroke attributed to 50 
      to 99% ICAS confirmed by computed tomographic angiography (CTA). With CTA-based 
      CFD models, translesional pressure ratio (PR = pressure(poststenotic) 
      /pressure(prestenotic) ) and translesional wall shear stress ratio (WSSR = 
      WSS(stenotic - throat) /WSS(prestenotic) ) were obtained in each sICAS lesion. 
      Translesional PR </= median was defined as low PR and WSSR >/=4th quartile as high 
      WSSR. All patients received standard medical treatment. The primary outcome was 
      recurrent ischemic stroke in the same territory (SIT) within 1 year. RESULTS: 
      Overall, 245 patients (median age = 61 years, 63.7% males) were analyzed. Median 
      translesional PR was 0.94 (interquartile range [IQR] = 0.87-0.97); median 
      translesional WSSR was 13.3 (IQR = 7.0-26.7). SIT occurred in 20 (8.2%) patients, 
      mostly with multiple infarcts in the border zone and/or cortical regions. In 
      multivariate Cox regression, low PR (adjusted hazard ratio [HR] = 3.16, 
      p = 0.026) and high WSSR (adjusted HR = 3.05, p = 0.014) were independently 
      associated with SIT. Patients with both low PR and high WSSR had significantly 
      higher risk of SIT than those with normal PR and WSSR (risk = 17.5% vs 3.0%, 
      adjusted HR = 7.52, p = 0.004). INTERPRETATION: This work represents a step 
      forward in utilizing computational flow simulation techniques in studying 
      intracranial atherosclerotic disease. It reveals a hemodynamic pattern of sICAS 
      that is more prone to stroke relapse, and supports hypoperfusion and 
      artery-to-artery embolism as common mechanisms of ischemic stroke in such 
      patients. Ann Neurol 2019;85:752-764.
CI  - (c) 2019 American Neurological Association.
FAU - Leng, Xinyi
AU  - Leng X
AUID- ORCID: 0000-0001-7300-6647
AD  - Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong 
      Kong, China.
AD  - Shenzhen Research Institute, Chinese University of Hong Kong, Shenzhen, China.
FAU - Lan, Linfang
AU  - Lan L
AD  - Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong 
      Kong, China.
AD  - Department of Neurology, First Affiliated Hospital of Sun Yat-sen University, 
      Guangzhou, China.
FAU - Ip, Hing Lung
AU  - Ip HL
AD  - Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong 
      Kong, China.
FAU - Abrigo, Jill
AU  - Abrigo J
AD  - Department of Imaging and Interventional Radiology, Chinese University of Hong 
      Kong, Hong Kong, China.
FAU - Scalzo, Fabien
AU  - Scalzo F
AD  - Neurovascular Imaging Research Core and UCLA Stroke Center, Department of 
      Neurology, University of California, Los Angeles, Los Angeles, CA.
FAU - Liu, Haipeng
AU  - Liu H
AD  - Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong 
      Kong, China.
AD  - Department of Imaging and Interventional Radiology, Chinese University of Hong 
      Kong, Hong Kong, China.
FAU - Feng, Xueyan
AU  - Feng X
AD  - Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong 
      Kong, China.
FAU - Chan, Ka Lung
AU  - Chan KL
AD  - Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong 
      Kong, China.
FAU - Fan, Florence S Y
AU  - Fan FSY
AD  - Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong 
      Kong, China.
FAU - Ma, Sze Ho
AU  - Ma SH
AD  - Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong 
      Kong, China.
FAU - Fang, Hui
AU  - Fang H
AD  - Department of Neurology, First Affiliated Hospital of Zhengzhou University, 
      Zhengzhou, China.
FAU - Xu, Yuming
AU  - Xu Y
AD  - Department of Neurology, First Affiliated Hospital of Zhengzhou University, 
      Zhengzhou, China.
FAU - Li, Jingwei
AU  - Li J
AD  - Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of 
      Nanjing University Medical School, Nanjing, China.
FAU - Zhang, Bing
AU  - Zhang B
AD  - Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of 
      Nanjing University Medical School, Nanjing, China.
FAU - Xu, Yun
AU  - Xu Y
AD  - Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of 
      Nanjing University Medical School, Nanjing, China.
FAU - Soo, Yannie O Y
AU  - Soo YOY
AD  - Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong 
      Kong, China.
FAU - Mok, Vincent C T
AU  - Mok VCT
AD  - Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong 
      Kong, China.
FAU - Yu, Simon C H
AU  - Yu SCH
AD  - Department of Imaging and Interventional Radiology, Chinese University of Hong 
      Kong, Hong Kong, China.
FAU - Liebeskind, David S
AU  - Liebeskind DS
AD  - Neurovascular Imaging Research Core and UCLA Stroke Center, Department of 
      Neurology, University of California, Los Angeles, Los Angeles, CA.
FAU - Wong, Ka Sing
AU  - Wong KS
AD  - Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong 
      Kong, China.
FAU - Leung, Thomas W
AU  - Leung TW
AD  - Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong 
      Kong, China.
LA  - eng
GR  - 14117414/General Research Fund/International
GR  - Hong Kong Research Grants Council/International
GR  - 2017QNRC001/Young Elite Scientist Sponsorship Program 2017-2019/International
GR  - China Association for Science and Technology/International
GR  - N_CUHK421/16/National Natural Science Foundation of China/Research Grants Council 
      Joint Research Scheme/International
GR  - 81661168015/National Natural Science Foundation of China/Research Grants Council 
      Joint Research Scheme/International
GR  - Lee Hysan Postdoctoral Fellowship in Clinical Neurosciences/International
GR  - Kwok Tak Seng Centre for Stroke Research and Intervention/International
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20190403
PL  - United States
TA  - Ann Neurol
JT  - Annals of neurology
JID - 7707449
SB  - IM
MH  - Aged
MH  - Brain Ischemia/*diagnostic imaging/epidemiology/physiopathology
MH  - Cohort Studies
MH  - Female
MH  - Follow-Up Studies
MH  - Hemodynamics/*physiology
MH  - Humans
MH  - Intracranial Arteriosclerosis/*diagnostic imaging/epidemiology/physiopathology
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Stroke/*diagnostic imaging/epidemiology/physiopathology
EDAT- 2019/03/07 06:00
MHDA- 2020/02/14 06:00
CRDT- 2019/03/07 06:00
PHST- 2018/11/12 00:00 [received]
PHST- 2019/03/04 00:00 [revised]
PHST- 2019/03/05 00:00 [accepted]
PHST- 2019/03/07 06:00 [pubmed]
PHST- 2020/02/14 06:00 [medline]
PHST- 2019/03/07 06:00 [entrez]
AID - 10.1002/ana.25456 [doi]
PST - ppublish
SO  - Ann Neurol. 2019 May;85(5):752-764. doi: 10.1002/ana.25456. Epub 2019 Apr 3.