Yuying Liu, Xuan Tian, Jill Abrigo, Shuang Li, Yu Liu, Linfang Lan, Haipeng Liu, Bonaventure Y M Ip, Sze Ho Ma, Karen Ma, Florence S Y Fan, Hing Lung Ip, Yannie O Y Soo, Howan Leung, Vincent C T Mok, Thomas W Leung, Xinyi Leng
{"title":"经医学治疗的症状性大脑中动脉狭窄患者，横切面压力梯度增大可促进脑膜侧支的招募。","authors":"Yuying Liu, Xuan Tian, Jill Abrigo, Shuang Li, Yu Liu, Linfang Lan, Haipeng Liu, Bonaventure Y M Ip, Sze Ho Ma, Karen Ma, Florence S Y Fan, Hing Lung Ip, Yannie O Y Soo, Howan Leung, Vincent C T Mok, Thomas W Leung, Xinyi Leng","doi":"10.1159/000547147","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>Evolution patterns and contributing factors of leptomeningeal collaterals (LMCs) in symptomatic intracranial atherosclerotic stenosis (sICAS) remain elusive.</p><p><strong>Methods: </strong>Patients with atherosclerotic M1 middle cerebral artery (MCA-M1) stenosis (50%-99%), who were treated medically and had CT angiography (CTA) at baseline and 1 year, were recruited. LMC status was determined by the laterality of distal vessels in anterior and posterior cerebral artery territories in baseline and 1-year CTA. Computational fluid dynamics models were constructed based on baseline and 1-year CTA, to quantify post-stenotic to pre-stenotic pressure ratio (PR) in MCA-M1 lesions. Decreased PR over 1 year indicated enlarged translesional pressure gradient.</p><p><strong>Results: </strong>Among 33 patients (median age 62 years), 18 (54.5%) and 15 (45.5%) had good and poor baseline LMCs; 11 (33.3%) and 22 (66.7%) had good and poor 1-year LMCs. Twelve (36.4%), 16 (48.5%) and 5 (15.2%) patients had worse, similar and better LMCs at 1 year versus baseline. Sixteen (48.5%) patients had decreased PR over 1 year, associated with good LMCs at 1 year (adjusted odds ratio 6.40; p=0.038), independent of baseline LMC status.</p><p><strong>Conclusion: </strong>LMCs may evolve over time in medically treated sICAS patients, when an enlarged translesional pressure gradient may be a driving force.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-17"},"PeriodicalIF":1.5000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Enlarged translesional pressure gradient drives recruitment of leptomeningeal collaterals in medically treated patients with symptomatic middle cerebral artery stenosis.\",\"authors\":\"Yuying Liu, Xuan Tian, Jill Abrigo, Shuang Li, Yu Liu, Linfang Lan, Haipeng Liu, Bonaventure Y M Ip, Sze Ho Ma, Karen Ma, Florence S Y Fan, Hing Lung Ip, Yannie O Y Soo, Howan Leung, Vincent C T Mok, Thomas W Leung, Xinyi Leng\",\"doi\":\"10.1159/000547147\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>Evolution patterns and contributing factors of leptomeningeal collaterals (LMCs) in symptomatic intracranial atherosclerotic stenosis (sICAS) remain elusive.</p><p><strong>Methods: </strong>Patients with atherosclerotic M1 middle cerebral artery (MCA-M1) stenosis (50%-99%), who were treated medically and had CT angiography (CTA) at baseline and 1 year, were recruited. LMC status was determined by the laterality of distal vessels in anterior and posterior cerebral artery territories in baseline and 1-year CTA. Computational fluid dynamics models were constructed based on baseline and 1-year CTA, to quantify post-stenotic to pre-stenotic pressure ratio (PR) in MCA-M1 lesions. Decreased PR over 1 year indicated enlarged translesional pressure gradient.</p><p><strong>Results: </strong>Among 33 patients (median age 62 years), 18 (54.5%) and 15 (45.5%) had good and poor baseline LMCs; 11 (33.3%) and 22 (66.7%) had good and poor 1-year LMCs. Twelve (36.4%), 16 (48.5%) and 5 (15.2%) patients had worse, similar and better LMCs at 1 year versus baseline. Sixteen (48.5%) patients had decreased PR over 1 year, associated with good LMCs at 1 year (adjusted odds ratio 6.40; p=0.038), independent of baseline LMC status.</p><p><strong>Conclusion: </strong>LMCs may evolve over time in medically treated sICAS patients, when an enlarged translesional pressure gradient may be a driving force.</p>\",\"PeriodicalId\":9683,\"journal\":{\"name\":\"Cerebrovascular Diseases\",\"volume\":\" \",\"pages\":\"1-17\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2025-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cerebrovascular Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000547147\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cerebrovascular Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000547147","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Enlarged translesional pressure gradient drives recruitment of leptomeningeal collaterals in medically treated patients with symptomatic middle cerebral artery stenosis.
Aims: Evolution patterns and contributing factors of leptomeningeal collaterals (LMCs) in symptomatic intracranial atherosclerotic stenosis (sICAS) remain elusive.
Methods: Patients with atherosclerotic M1 middle cerebral artery (MCA-M1) stenosis (50%-99%), who were treated medically and had CT angiography (CTA) at baseline and 1 year, were recruited. LMC status was determined by the laterality of distal vessels in anterior and posterior cerebral artery territories in baseline and 1-year CTA. Computational fluid dynamics models were constructed based on baseline and 1-year CTA, to quantify post-stenotic to pre-stenotic pressure ratio (PR) in MCA-M1 lesions. Decreased PR over 1 year indicated enlarged translesional pressure gradient.
Results: Among 33 patients (median age 62 years), 18 (54.5%) and 15 (45.5%) had good and poor baseline LMCs; 11 (33.3%) and 22 (66.7%) had good and poor 1-year LMCs. Twelve (36.4%), 16 (48.5%) and 5 (15.2%) patients had worse, similar and better LMCs at 1 year versus baseline. Sixteen (48.5%) patients had decreased PR over 1 year, associated with good LMCs at 1 year (adjusted odds ratio 6.40; p=0.038), independent of baseline LMC status.
Conclusion: LMCs may evolve over time in medically treated sICAS patients, when an enlarged translesional pressure gradient may be a driving force.
期刊介绍：
A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.
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