Cerebrovascular diseases (Basel, Switzerland) · 2025
Enlarged Translesional Pressure Gradient Drives Recruitment of Leptomeningeal Collaterals in Medically Treated Patients with Symptomatic Middle Cerebral Artery Stenosis.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Liu Yuying, Tian Xuan, Abrigo Jill, Li Shuang, Liu Yu, Lan Linfang, Liu Haipeng, Ip Bonaventure Y M, Ma Sze Ho, Ma Karen, Fan Florence S Y, Ip Hing Lung, Soo Yannie O Y, Leung Howan, Mok Vincent C T, Leung Thomas W, Leng Xinyi
Аннотация
UNLABELLED: <p>Introduction: 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. </p>.
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. </p>.
Предметные рубрики MeSH
HumansMiddle AgedMaleFemaleAgedCollateral CirculationCerebrovascular CirculationTreatment OutcomeMiddle Cerebral ArteryComputed Tomography AngiographyTime FactorsCerebral AngiographyIntracranial ArteriosclerosisInfarction, Middle Cerebral ArteryModels, CardiovascularArterial PressureMeningeal Arteries