Hemodynamics and stroke risk in intracranial atherosclerotic disease

Xinyi Leng, Linfang Lan, Hing Lung Ip, Jill Abrigo, Fabien Scalzo, Haipeng Liu, Xueyan Feng, Ka Lung Chan, Florence S.Y. Fan, Sze Ho Ma, Hui Fang, Yuming Xu, Jingwei Li, Bing Zhang, Yun Xu, Yannie O.Y. Soo, Vincent C.T. Mok, Simon C.H. Yu, David S. Liebeskind, Ka Sing WongThomas W. Leung

Research output: Contribution to journalArticlepeer-review

45 Citations (Scopus)


Objective: To investigate whether hemodynamic features of symptomatic intracranial atherosclerotic stenosis (sICAS) might correlate with the risk of stroke relapse, using a computational fluid dynamics (CFD) model. Methods: In a cohort study, we recruited patients with acute ischemic stroke attributed to 50 to 99% ICAS confirmed by computed tomographic angiography (CTA). With CTA-based CFD models, translesional pressure ratio (PR = pressure poststenotic /pressure prestenotic ) and translesional wall shear stress ratio (WSSR = WSS stenotic − throat /WSS prestenotic ) were obtained in each sICAS lesion. Translesional PR ≤ median was defined as low PR and WSSR ≥4th quartile as high WSSR. All patients received standard medical treatment. The primary outcome was recurrent ischemic stroke in the same territory (SIT) within 1 year. Results: Overall, 245 patients (median age = 61 years, 63.7% males) were analyzed. Median translesional PR was 0.94 (interquartile range [IQR] = 0.87–0.97); median translesional WSSR was 13.3 (IQR = 7.0–26.7). SIT occurred in 20 (8.2%) patients, mostly with multiple infarcts in the border zone and/or cortical regions. In multivariate Cox regression, low PR (adjusted hazard ratio [HR] = 3.16, p = 0.026) and high WSSR (adjusted HR = 3.05, p = 0.014) were independently associated with SIT. Patients with both low PR and high WSSR had significantly higher risk of SIT than those with normal PR and WSSR (risk = 17.5% vs 3.0%, adjusted HR = 7.52, p = 0.004). Interpretation: This work represents a step forward in utilizing computational flow simulation techniques in studying intracranial atherosclerotic disease. It reveals a hemodynamic pattern of sICAS that is more prone to stroke relapse, and supports hypoperfusion and artery-to-artery embolism as common mechanisms of ischemic stroke in such patients. Ann Neurol 2019;85:752–764.

Original languageEnglish
Pages (from-to)752-764
Number of pages13
JournalAnnals of Neurology
Issue number5
Early online date3 Apr 2019
Publication statusPublished - May 2019
Externally publishedYes

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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