Quantifying Intracranial Internal Carotid Artery Stenosis on MR Angiography.

TitleQuantifying Intracranial Internal Carotid Artery Stenosis on MR Angiography.
Publication TypeJournal Article
Year of Publication2017
AuthorsBaradaran H, Patel P, Gialdini G, Al-Dasuqi K, Giambrone A, Kamel H, Gupta A
JournalAJNR Am J Neuroradiol
Date Published2017 May
KeywordsAged, Carotid Artery, Internal, Carotid Stenosis, Female, Humans, Magnetic Resonance Angiography, Male, Middle Aged, Prospective Studies

BACKGROUND AND PURPOSE: Intracranial atherosclerosis is a common cause of ischemic stroke. Intracranial stenosis is most commonly quantified by the Warfarin-Aspirin Symptomatic Intracranial Disease method, which involves calculating a ratio of luminal diameter measurements on conventional angiography. Our purpose was to determine whether a single linear measurement of the narrowest caliber of the intracranial ICA on MRA can accurately predict Warfarin-Aspirin Symptomatic Intracranial Disease stenosis measurements.

MATERIALS AND METHODS: We identified patients from a prospective stroke registry who had undergone head MRAs to quantitatively evaluate the degree of Warfarin-Aspirin Symptomatic Intracranial Disease-derived stenosis in each intracranial ICA. We also made a single linear millimeter measurement at the site of maximal narrowing of the ICA. We calculated a correlation coefficient between the lumen diameter in millimeters and percentage Warfarin-Aspirin Symptomatic Intracranial Disease stenosis. We performed receiver operating characteristic analysis to determine optimal luminal diameter cutoff values.

RESULTS: In 386 unique intracranial ICAs, we found a strong linear relationship between single lumen measurements and Warfarin-Aspirin Symptomatic Intracranial Disease-style stenosis measurements (R = -0.84, P < .0001). We found that ICA lumen diameters of ≤2.1 and ≤1.3 mm were optimal cutoffs for identifying patients with ≥50% stenosis and ≥70% stenosis, respectively (area under the curve = 0.96 and 0.99, respectively).

CONCLUSIONS: There is a strong linear relationship between the narrowest lumen diameter of the intracranial ICA and percentage stenosis. Our results suggest that a single lumen diameter measurement on MRA allows accurate estimation of Warfarin-Aspirin Symptomatic Intracranial Disease stenosis, which may affect risk stratification and treatment decisions.

Alternate JournalAJNR Am J Neuroradiol
PubMed ID28302605
PubMed Central IDPMC5433892
Grant ListK23 NS082367 / NS / NINDS NIH HHS / United States
KL2 TR000458 / TR / NCATS NIH HHS / United States