Vessel Shrinkage and Stroke Recurrence in Intracranial Atherosclerotic Stenosis Under Intensive Lipid-Lowering Therapy

作者：Weizhuang Yuan, Zhongrui Yan, Baoquan Lu, Xiaoyun Liu, Ailian Du, Dai‐Shi Tian, Le Fang, Changyun Liu, Guangzhi Liu, Bo Wu, Hebo Wang, Tao Gong, Zhimin Shi, Mingli Li, Xinzhi Hu, Caiyan Liu, Yuelun Zhang, Yan Xu, Wei‐Hai Xu · 发表于：Stroke · 年份：2025 · DOI：10.1161/strokeaha.125.051719 · 被引用次数：2 · 研究领域：Cerebrovascular and Carotid Artery Diseases、Coronary Interventions and Diagnostics、Intracranial Aneurysms: Treatment and Complications

BACKGROUND: Little is known about the dynamic process of the outer-wall boundary during intensive lipid-lowering therapy in patients with intracranial atherosclerotic stenosis and its clinical implications. METHODS: We analyzed patients with first-ever acute ischemic stroke attributed to intracranial atherosclerotic stenosis who received intensive lipid-lowering therapy with high-dose statins or PCSK9i (proprotein convertase subtilisin/kexin type 9 inhibitor). Data were obtained from a multicenter cohort study at 15 hospitals across China and our institutional database in Beijing, China. All patients underwent 3-dimensional T1-weighted high-resolution magnetic resonance vessel wall imaging at baseline and after a >6-month follow-up period. Outer-wall boundary area changes were classified as expansion (>10% increase), shrinkage (>10% decrease), or quiescence (≤10% change). The association between these changes and time to recurrent ipsilateral stroke was assessed. The Kaplan-Meier method and the Cox proportional hazards model were used. RESULTS: Among the 137 patients, 50 (36.5%) exhibited expansion, 40 (29.2%) shrinkage, and 47 (34.3%) quiescence of the outer-wall boundary area. Among these 3 groups, plaque burden decreased significantly between the index imaging and follow-up (all P ≤ 0 .02). Lumen area increased significantly in patients with expansion ( P <0.001) and quiescence ( P =0.01) but not in those with shrinkage of the outer-wall boundary area ( P =0.34...