Abstract TMP16: Morphologic Evolution and Remodelling of Intracranial Atherosclerosis Under Intensive Risk Factor Control
Introduction: In SAMMPRIS, the benefit of aggressive medical therapy over stenting persisted throughout the extended follow-up. It is uncertain how modern medical management could diminish stroke relapses.
Method: In a prospective academic-initiated study, we recruited 40 patients (mean age 63.4±9.0 years) with acute strokes attributed to high-grade (≥70%) intracranial atherosclerotic stenosis for 3D-rotational angiograms before and after intensive medical therapy for 12 months. Treatment targets included low-density lipoprotein <70 mg/dl; HbA1c <6.5%; and systolic blood pressure <140 mmHg. We analyzed the morphologic and geometric evolution of the symptomatic plaques.
Results: Overall, the risk factor control reached the pre-specified intensity. Plaque thickness, and hence luminal narrowing, significantly diminished at one year (from 1.50±0.48 to 1.24±0.42mm; p<0.001). The site of maximal stenosis shifted significantly towards mid-portion of the plaque (p<0.001), leading to a diminished upstream angulation. The ulcers noted at baseline (n=3) had all healed by one year. There was no significant change in terms of plaque length or lesion eccentricity.
Conclusion: Intracranial plaques might regress and positively remodel under intensive risk factor control. These morphologic changes might stabilise the plaques, alleviate unfavourable hemodynamics across the steno-occlusion, and hence reduce the risk of plaque rupture or platelet aggregation.
Author Disclosures: T. Leung: None. Y. Soo: None. V. Ip: None. K. Wong: None. S. Yu: None.
- © 2016 by American Heart Association, Inc.