Stroke risk prediction in symptomatic anterior circulation ICAD: Analysis of regional QMRA flow from the MYRIAD study

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-04-15 DOI:10.1016/j.jstrokecerebrovasdis.2025.108322

Sepideh Amin-Hanjani MD , Theresa Elder MD , Xinjian Du MD MPH , Jose G. Romano MD , David S. Liebeskind MD , Adam De Havenon MD , Arindam Rano Chatterjee MD , Shyam Prabhakaran MD

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Abstract

Background

Intracranial atherosclerotic disease (ICAD) remains a major source of stroke world-wide, with high recurrence risk. Prior evaluation of posterior circulation ICAD patients enrolled in the prospective VERiTAS and MYRIAD studies revealed regional hypoperfusion assessed by large vessel flow measurements using quantitative MRA (QMRA) predicts subsequent stroke risk. We examined whether a similar approach to regional flow assessment predicted stroke risk in anterior circulation ICAD patients in MYRIAD.

Methods

MYRIAD enrolled patients with symptomatic 50-99 % stenosis of proximal intracranial artery. The primary outcome was recurrent ischemic stroke in the stenotic artery territory within one year. Flow was measured in the major intracranial arteries at baseline using QMRA. We designated patients as low or normal flow based on an algorithm assessing distal flow and collateral capacity using age-normalized middle cerebral artery (MCA) and hemispheric flows. Thresholds for flow status categorization were tested to determine the optimal algorithm for stroke risk prediction.

Results

Of 73 enrolled subjects with symptomatic anterior circulation ICAD, 7 (9.6 %) had recurrent stroke. Z-score thresholds for age-normalized flow were examined, from which we identified an optimal threshold of -1 for the MCA and -0.75 for hemispheric flow. Based on these thresholds, 24 (33 %) patients were categorized as low flow; recurrent stroke occurred in 21 % of low flow vs 4 % of normal flow patients (age adjusted OR 7.2, 95 % CI 1.2-43.2). In the full cohort of 99 subjects with anterior and posterior circulation ICAD, 11 (11.1 %) had recurrent stroke, with a higher recurrent stroke risk in low flow patients (21.4 % vs 7 %, age adjusted OR 3.8, 95 % CI 1.02-14.2).

Conclusions

Distal flow status assessed through QMRA regional flow measurement appears to be similarly predictive for recurrent clinical stroke in both the anterior and posterior ciruclation. Identification of high-risk patients has implications for future investigation of therapeutic interventions.

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症状性前循环ICAD卒中风险预测：来自MYRIAD研究的区域QMRA流分析

背景颅内动脉粥样硬化性疾病（ICAD）仍是全球脑卒中的主要病因，复发风险很高。之前对参加前瞻性 VERiTAS 和 MYRIAD 研究的后循环 ICAD 患者进行的评估显示，使用定量 MRA（QMRA）测量大血管血流评估的区域低灌注可预测后续卒中风险。我们研究了类似的区域血流评估方法是否能预测 MYRIAD 中前循环 ICAD 患者的卒中风险。主要结果是一年内在狭窄动脉区域内复发缺血性中风。基线时使用 QMRA 测量颅内主要动脉的血流量。我们根据使用年龄归一化的大脑中动脉（MCA）和半球血流评估远端血流和侧支能力的算法将患者分为低血流和正常血流。对血流状态分类的阈值进行了测试，以确定预测卒中风险的最佳算法。结果在 73 名有症状的前循环 ICAD 受试者中，有 7 人（9.6%）再次发生卒中。我们研究了年龄归一化血流的 Z 值阈值，从中确定了 MCA 的最佳阈值为-1，半球血流的最佳阈值为-0.75。根据这些阈值，24 例（33%）患者被归类为低血流；21% 的低血流患者与 4%的正常血流患者相比发生了复发性中风（年龄调整 OR 7.2，95% CI 1.2-43.2）。结论通过 QMRA 区域血流测量评估的远端血流状态似乎同样可预测前循环和后循环的复发性临床卒中。识别高危患者对未来的治疗干预研究具有重要意义。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.