Abstract T P104: Remodeling of Intracranial Atherosclerotic Plaques
Background: Rupture-prone plaques may cause recurrent thrombo-embolic stroke. Little is known how symptomatic intracranial atherosclerotic plaques would remodel under current treatment.
Method: We recruited acute stroke patients with high-grade (>70%) symptomatic intracranial atherosclerotic stenosis for optimal medical treatment. Interval changes of plaque morphology were assessed by 3D-rotational angiography at baseline and 12 months. Morphological parameters included plaque surface (smooth/irregular/ulcerated), thickness, length (total length, maximal stenosis length), maximal stenosis distribution (proximal/central/distal), thickness-to-length ratio (ratio=thickness/total length), eccentricity, and plaque upstroke angulation. We stratified angiographic outcomes into 1) Progressive (surface morphology evolved from smooth to become irregular/ulcerated); 2) Static (surface morphology unchanged); and 3) Regressive (surface morphology from irregular/ulcerated to smooth).
Results: Among the recruited 32 patients (age 66.3±8.9yrs, male 71.9%), we observed significant difference in plaque surface (ulcerated: 21.9% to 9.4%, p=0.01), thickness (1.54±0.41mm to 1.33±0.45mm, p=0.01), maximal stenosis distribution (central: 50.0% to 65.6%, p<0.001), and thickness-to-length ratio (0.30±0.13 to 0.26±0.10, p=0.046). Plaque surface morphology remained unchanged in 25 patients (78.1%), progressive in 2 patients (6.3%), and regressive in 5 patients (15.6%, Figure). One patient (3%) developed recurrent ischemic stroke.
Conclusion: Symptomatic intracranial atherosclerotic plaques may regress with medical therapy alone. Healing of ulcers and positive remodeling are evident in some plaques.
Author Disclosures: L. Wang: None. S. Yu: None. D. Siu: None. Y. Soo: None. L. Wong: None. T. Leung: None.
- © 2015 by American Heart Association, Inc.