Cerebral haemodynamics in symptomatic intracranial atherosclerotic disease: a narrative review of the assessment methods and clinical implications
Intracranial atherosclerotic disease (ICAD) is a common cause of ischaemic stroke and transient ischaemic attack (TIA) with a high recurrence rate. It is often referred to as intracranial atherosclerotic stenosis (ICAS), when the plaque has caused significant narrowing of the vessel lumen. The lesio...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
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| Series: | Stroke and Vascular Neurology |
| Online Access: | https://svn.bmj.com/content/early/2023/04/24/svn-2023-002333.full |
| _version_ | 1797840070946848768 |
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| author | Liping Liu Xinyi Leng David S Liebeskind Thomas W Leung Shuang Li Xuan Tian Yuying Liu |
| author_facet | Liping Liu Xinyi Leng David S Liebeskind Thomas W Leung Shuang Li Xuan Tian Yuying Liu |
| author_sort | Liping Liu |
| collection | DOAJ |
| description | Intracranial atherosclerotic disease (ICAD) is a common cause of ischaemic stroke and transient ischaemic attack (TIA) with a high recurrence rate. It is often referred to as intracranial atherosclerotic stenosis (ICAS), when the plaque has caused significant narrowing of the vessel lumen. The lesion is usually considered ‘symptomatic ICAD/ICAS’ (sICAD/sICAS) when it has caused an ischaemic stroke or TIA. The severity of luminal stenosis has long been established as a prognostic factor for stroke relapse in sICAS. Yet, accumulating studies have also reported the important roles of plaque vulnerability, cerebral haemodynamics, collateral circulation, cerebral autoregulation and other factors in altering the stroke risks across patients with sICAS. In this review article, we focus on cerebral haemodynamics in sICAS. We reviewed imaging modalities/methods in assessing cerebral haemodynamics, the haemodynamic metrics provided by these methods and application of these methods in research and clinical practice. More importantly, we reviewed the significance of these haemodynamic features in governing the risk of stroke recurrence in sICAS. We also discussed other clinical implications of these haemodynamic features in sICAS, such as the associations with collateral recruitment and evolution of the lesion under medical treatment, and indications for more individualised blood pressure management for secondary stroke prevention. We then put forward some knowledge gaps and future directions on these topics. |
| first_indexed | 2024-04-09T16:07:20Z |
| format | Article |
| id | doaj.art-4c7fb99335bd4586ae5bf4fadb517152 |
| institution | Directory Open Access Journal |
| issn | 2059-8696 |
| language | English |
| last_indexed | 2024-04-09T16:07:20Z |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Stroke and Vascular Neurology |
| spelling | doaj.art-4c7fb99335bd4586ae5bf4fadb5171522023-04-25T00:30:06ZengBMJ Publishing GroupStroke and Vascular Neurology2059-869610.1136/svn-2023-002333Cerebral haemodynamics in symptomatic intracranial atherosclerotic disease: a narrative review of the assessment methods and clinical implicationsLiping Liu0Xinyi Leng1David S Liebeskind2Thomas W Leung3Shuang Li4Xuan Tian5Yuying Liu6China National Clinical Research Center for Neurological Diseases, Beijing, China1 Department of Medicine and Therapeutics, The Chinese University, Hong Kong, ChinaDepartment of Neurology, University of California Los Angeles, Los Angeles, California, USA1 Department of Medicine and Therapeutics, The Chinese University, Hong Kong, ChinaDepartment of General Surgery, First Affiliated Hospital of Dalian Medical University, Dalian, China1 Department of Medicine and Therapeutics, The Chinese University, Hong Kong, ChinaDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, People`s Republic of ChinaIntracranial atherosclerotic disease (ICAD) is a common cause of ischaemic stroke and transient ischaemic attack (TIA) with a high recurrence rate. It is often referred to as intracranial atherosclerotic stenosis (ICAS), when the plaque has caused significant narrowing of the vessel lumen. The lesion is usually considered ‘symptomatic ICAD/ICAS’ (sICAD/sICAS) when it has caused an ischaemic stroke or TIA. The severity of luminal stenosis has long been established as a prognostic factor for stroke relapse in sICAS. Yet, accumulating studies have also reported the important roles of plaque vulnerability, cerebral haemodynamics, collateral circulation, cerebral autoregulation and other factors in altering the stroke risks across patients with sICAS. In this review article, we focus on cerebral haemodynamics in sICAS. We reviewed imaging modalities/methods in assessing cerebral haemodynamics, the haemodynamic metrics provided by these methods and application of these methods in research and clinical practice. More importantly, we reviewed the significance of these haemodynamic features in governing the risk of stroke recurrence in sICAS. We also discussed other clinical implications of these haemodynamic features in sICAS, such as the associations with collateral recruitment and evolution of the lesion under medical treatment, and indications for more individualised blood pressure management for secondary stroke prevention. We then put forward some knowledge gaps and future directions on these topics.https://svn.bmj.com/content/early/2023/04/24/svn-2023-002333.full |
| spellingShingle | Liping Liu Xinyi Leng David S Liebeskind Thomas W Leung Shuang Li Xuan Tian Yuying Liu Cerebral haemodynamics in symptomatic intracranial atherosclerotic disease: a narrative review of the assessment methods and clinical implications Stroke and Vascular Neurology |
| title | Cerebral haemodynamics in symptomatic intracranial atherosclerotic disease: a narrative review of the assessment methods and clinical implications |
| title_full | Cerebral haemodynamics in symptomatic intracranial atherosclerotic disease: a narrative review of the assessment methods and clinical implications |
| title_fullStr | Cerebral haemodynamics in symptomatic intracranial atherosclerotic disease: a narrative review of the assessment methods and clinical implications |
| title_full_unstemmed | Cerebral haemodynamics in symptomatic intracranial atherosclerotic disease: a narrative review of the assessment methods and clinical implications |
| title_short | Cerebral haemodynamics in symptomatic intracranial atherosclerotic disease: a narrative review of the assessment methods and clinical implications |
| title_sort | cerebral haemodynamics in symptomatic intracranial atherosclerotic disease a narrative review of the assessment methods and clinical implications |
| url | https://svn.bmj.com/content/early/2023/04/24/svn-2023-002333.full |
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