Intracranial Atherosclerotic Burden on 7T MRI Is Associated with Markers of Extracranial Atherosclerosis: The SMART-MR Study

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Intracranial atherosclerosis, a major risk factor for ischemic stroke, is thought to have different atherogenic mechanisms than extracranial atherosclerosis. Studies investigating their relationship in vivo are sparse and report inconsistent results. Within the Second Manifestations of ARTerial disease–Magnetic Resonance (SMART) Study, cross-sectional analyses were performed in 130 patients with a history of vascular disease and with assessable 7T intracranial vessel wall MR imaging data. Intracranial atherosclerosis burden was defined as the number of intracranial vessel wall lesions in the circle of Willis and its major branches. Significant associations were observed between higher intracranial atherosclerosis burden and carotid intima-media thickness, 50%–100% carotid stenosis versus no stenosis, ankle-brachial index, and estimated glomerular filtration rate. No significant differences in intracranial atherosclerosis burden were found among different categories of vascular disease.

Abstract

BACKGROUND AND PURPOSE

Examples of intracranial vessel wall lesions on vessel wall MR imaging in a 76-year-old male patient with a history of coronary artery disease. A detailed description of the rating criteria can be found in the Materials and Methods section. A, Lesion in lateral wall of the right P2 segment (arrow) versus the nondiscernable normal neighboring medial wall (arrowhead). B, Lesion in the right vertebral (arrow) and left vertebral (arrowhead) arteries. C, Lesion in the proximal basilar artery (arrow), with coronal orientation shown in enclosed panel (arrowhead). D, Lesion in the C7 segment of the right ICA (arrow), compared with the normal-appearing contralateral C7 segment (arrowhead) and proximal right M1 segment. Furthermore, note the long lesion in the distal half of the right P2 segment (gray arrow) and focal lesion in the left P2 segment (dual arrow).

Intracranial atherosclerosis, a major risk factor for ischemic stroke, is thought to have different atherogenic mechanisms than extracranial atherosclerosis. Studies investigating their relationship in vivo are sparse and report inconsistent results. We studied the relationship between intracranial atherosclerosis and extracranial atherosclerosis in a cohort of patients with a history of vascular disease.

MATERIALS AND METHODS

Within the Second Manifestations of ARTerial disease–Magnetic Resonance (SMART) study, cross-sectional analyses were performed in 130 patients (mean age, 68 ± 9 years) with a history of vascular disease and with assessable 7T intracranial vessel wall MR imaging data. Intracranial atherosclerosis burden was defined as the number of intracranial vessel wall lesions in the circle of Willis and its major branches. Age- and sex-adjusted unstandardized regression coefficients (b-value) were calculated with intracranial atherosclerosis burden as the dependent variable and extracranial atherosclerosis markers as independent variables.

RESULTS

Ninety-six percent of patients had ≥1 vessel wall lesion, with a mean intracranial atherosclerosis burden of 8.5 ± 5.7 lesions. Significant associations were observed between higher intracranial atherosclerosis burden and carotid intima-media thickness (b = 0.53 lesions per +0.1  mm; 95% CI, 0.1–1.0 lesions), 50%–100% carotid stenosis versus no stenosis (b = 6.6 lesions; 95% CI, 2.3–10.9 lesions), ankle-brachial index ≤ 0.9 versus >0.9 (b = 4.9 lesions; 95% CI, 1.7–8.0 lesions), and estimated glomerular filtration rate (b = –0.77 lesions per +10 mL/min; 95% CI, −1.50 to −0.03 lesions). No significant differences in intracranial atherosclerosis burden were found among different categories of vascular disease.

CONCLUSIONS

Intracranial atherosclerosis was associated with various extracranial markers of atherosclerosis, not supporting a different etiology.

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