title: Evolution of intracranial atherosclerotic disease under modern medical therapy.
abstract: OBJECTIVE
  Understanding how symptomatic intracranial atherosclerotic disease (ICAD) evolves with current medical therapy may inform secondary stroke prevention.
  
  
  METHODS
  In a prospective academic-initiated study, we recruited 50 patients (mean age = 63.4 ± 9.0 years) with acute strokes attributed to high-grade (≥70%) intracranial atherosclerotic stenosis for 3-dimensional rotational angiograms before and after intensive medical therapy for 12 months. Treatment targets included low-density lipoprotein ≤ 70mg/dl, glycosylated hemoglobin (HbA1c) ≤ 6.5%, and systolic blood pressure ≤ 140 mmHg. We analyzed infarct topography and monitored microembolic signal in recurrent strokes. The reference group was a published cohort of 143 ICAD patients.
  
  
  RESULTS
  Overall, the stenoses regressed from 79% at baseline (interquartile range [IQR] = 71-87%) to 63% (IQR = 54-74%) in 1 year (p < 0.001). Specifically, the qualifying lesions (n = 49) regressed (stenosis reduced >10%) in 24 patients (49%), remained quiescent (stenosis same or ±10%) in 21 patients (43%), and progressed (stenosis increased >10%) in 4 patients (8%). There was no difference in intensity of risk factor control between groups of diverging clinical or angiographic outcomes. Higher HbA1c at baseline predicted plaque regression at 1 year (odds ratio = 4.4, 95% confidence interval = 1.4-14.5, p = 0.006). Among the 6 patients with recurrent strokes pertaining to the qualifying stenosis, 5 patients had solitary or rosarylike acute infarcts along the internal or anterior border zones, and 2 patients showed microembolic signals in transcranial Doppler ultrasound.
  
  
  CONCLUSIONS
  A majority of symptomatic high-grade intracranial plaques had regressed or remained quiescent by 12 months under intensive medical therapy. Artery-to-artery thromboembolism with impaired washout at border zones was a common mechanism in stroke recurrence.
authors.affiliation: Division of Neurology, Department of Medicine and Therapeutics.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Leung
authors.forename: Lily
authors.initials: L
authors.lastname: Wang
authors.forename: Yannie O Y
authors.initials: YO
authors.lastname: Soo
authors.forename: Vincent H L
authors.initials: VH
authors.lastname: Ip
authors.forename: Anne Y Y
authors.initials: AY
authors.lastname: Chan
authors.forename: Lisa W C
authors.initials: LW
authors.lastname: Au
authors.forename: Florence S Y
authors.initials: FS
authors.lastname: Fan
authors.forename: Alex Y L
authors.initials: AY
authors.lastname: Lau
authors.forename: Howan
authors.initials: H
authors.lastname: Leung
authors.forename: Jill
authors.initials: J
authors.lastname: Abrigo
authors.forename: Adrian
authors.initials: A
authors.lastname: Wong
authors.forename: Vincent C T
authors.initials: VC
authors.lastname: Mok
authors.forename: Ping Wing
authors.initials: PW
authors.lastname: Ng
authors.forename: Tak Hong
authors.initials: TH
authors.lastname: Tsoi
authors.forename: Siu Hung
authors.initials: SH
authors.lastname: Li
authors.forename: Celeste B L
authors.initials: CB
authors.lastname: Man
authors.forename: Wing Chi
authors.initials: WC
authors.lastname: Fong
authors.forename: Ka Sing
authors.initials: KS
authors.lastname: Wong
authors.forename: Simon C H
authors.initials: SC
authors.lastname: Yu
mesh_terms: D000368:Aged; D002533:Cerebral Angiography; D003251:Constriction, Pathologic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000175:diagnosis / Q000188:drug therapy*; D012008:Recurrence; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome