J Stroke.  2023 Jan;25(1):132-140. 10.5853/jos.2022.02754.

Wall Shear Stress Associated with Stroke Occurrence and Mechanisms in Middle Cerebral Artery Atherosclerosis

• Woo HG
• Kim HG
• Lee KM
• Ha SH
• Jo H
• Heo SH
• Chang Di
• Liebeskind DS
• Kim BJ

• KMID: 2539066
• DOI: http://doi.org/10.5853/jos.2022.02754

Abstract

Background and Purpose
Various mechanisms are involved in the etiology of stroke caused by atherosclerosis of the middle cerebral artery (MCA). Here, we compared differences in plaque nature and hemodynamic parameters according to stroke mechanism in patients with MCA atherosclerosis.
Methods
Consecutive patients with asymptomatic and symptomatic MCA atherosclerosis (≥50% stenosis) were enrolled. MCA plaque characteristics (location and plaque enhancement) and wall shear stress (WSS) were measured using high-resolution vessel wall and four-dimensional flow magnetic resonance imaging, respectively, at five points (initial, upstream, minimal lumen, downstream, and terminal). These parameters were compared between patients with asymptomatic and symptomatic MCA atherosclerosis with infarctions of different mechanisms (artery-to-artery embolism vs. local branch occlusion).
Results
In total, 110 patients (46 asymptomatic, 32 artery-to-artery embolisms, and 32 local branch occlusions) were investigated. Plaques were evenly distributed in the MCA of patients with asymptomatic MCA atherosclerosis, more commonly observed in the distal MCA of patients with artery-to-artery embolism, and in the middle MCA of patients with local branch occlusion. Maximum WSS and plaque enhancement were more prominent in the minimum lumen area of patients with asymptomatic MCA atherosclerosis or those with local branch occlusion, and were more prominent in the upstream area in those with artery-to-artery embolism. The elevated variability in the maximum WSS was related to stroke caused by artery-to-artery embolism.
Conclusion
Stroke caused by artery-to-artery embolism was related to plaque enhancement and the highest maximum WSS at the upstream point of the plaque, and was associated with elevated variability of maximum WSS.

Keyword

Atherosclerosis; Atherosclerotic plaque; Stroke; Middle cerebral artery; Hemodynamics

Figure

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  Figure 1. Illustration of representative case with plaque enhancement in the middle cerebral artery. (A) Atherosclerotic plaque and significant stenosis in the middle cerebral artery. (B) Plaque enhancement (white arrowhead) can be seen on contrast-enhanced T1-weighted imaging. (C) Plaque enhancement (white arrowhead) and an atherosclerotic plaque (white arrow) are visible on high-resolution vessel wall magnetic resonance imaging. (D) Within the plaque, the location of the enhancement was measured at five points (initial, upstream, minimal lumen area, downstream, and terminal).

• 

  Figure 2. Representative cases of maximal wall shear stress (WSS) in patients with symptomatic middle cerebral artery stenosis (sMCA) with infarction caused by local branch occlusion (sMCA-LBO) and sMCA with infarction caused by artery-to-artery embolism (sMCA-AAE). (A) Infarction due to local branch occlusion. (B) Five points (initial, upstream, minimal lumen area, downstream, and terminal) of the sMCA. (C, D) The highest maximal WSS was observed from the minimal lumen area in patients with sMCA-LBO. (E) Infarction due to artery-to-artery embolism. (F) Five points (initial, upstream, minimal lumen area, downstream, and terminal) of sMCA. (G, H) The highest maximal WSS was observed from the upstream area in patients with sMCA-AAE. Five points: a, initial; b, upstream; c, minimal lumen area; d, downstream; e, terminal.

Reference

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