Application of High-Resolution Magnetic Resonance Vessel Wall Imaging in Endovascular Treatment

Application of High-Resolution Magnetic Resonance Vessel Wall Imaging in Endovascular Treatment: A Middle Cerebral Artery (MCA) Stenosis Cohort Study

Intracranial atherosclerotic disease (ICAD) is one of the most important causes of ischemic stroke and is also associated with some recurrent stroke. Safety and effective treatment of ICAD is an important precondition to improve the prognosis of patients. The current therapy for middle cerebral artery stenosis was medication and vascular intervention. Traditional assessment methods for intracranial artery, such as magnetic resonance angiography (MRA), computed tomography angiography (CTA) and digital subtraction angiography (DSA), could mainly assess the stenosis degree of the intracranial artery. While, the high-resolution magnetic vessel wall examination has been a pivotal image examination for diagnosing intracranial arterial disease and it provides a unique insight into the atherosclerotic lesions of vessel wall. Therefore, the study aims to explore the association between HRMRI-VWI enhancement for stroke recurrence in ICAS patients treated with MCA angioplasty.

This study is prospective observational study included patients with severe middle cerebral artery (MCA) stenosis who underwent percutaneous transluminal angioplasty and stenting (PTAS). On the basis of the enhancement of stenosis was similar or over than intracranial arterial wall without stenosis, we divided these patients into enhanced group (EVWE) and no-enhanced group (NE). The primary outcome was the occurrence of recurrent ischemic stroke in the territory of the treated MCA 15 months (±1 month) after angioplasty and stenting. The secondary outcomes included: 1) 15 months acute stroke including AIS AND ICH 2) peri-operation acute stroke including AIS AND ICH 3) the degree of in-stent restenosis (ISR) at 3 months(±1 week) and 15 months(±1 month) after the procedure, as measured by digital subtraction angiography (DSA) using the WASID criteria.

Inclusion Criteria:

1）patients aged between 18 and 80 years; 2) ischemic stroke or transient ischemic attack (TIA) involving the target artery within the preceding 90 days those presenting with symptomatic MCA stenosis of 70% or greater, as confirmed by digital subtraction angiography (DSA) based on the WASID criteria; 3) Treating of routine antiplatelet and statin treatment and risk factor management, while would accept cerebral artery angioplasty treatment ; 4) MRS score less than 2 points before angioplasty treatment 5) provided written informed consent.

Exclusion Criteria:

1) bilateral MCA stenosis or non-atherosclerotic vasculopathies such as moyamoya disease and vasculitis; 2) cardioembolic stroke or other defined etiologies according to the TOAST classification; 3) serious systemic comorbidities (e.g., heart failure, renal insufficiency, or malignancy) that could affect prognosis or procedural safety; 4) contraindications to MRI or contrast agents, including metal implants or severe allergic reactions and poor MRI imaging.