Hemodynamics is associated with vessel wall remodeling in patients with middle cerebral artery stenosis

Objectives To evaluate the relationship between hemodynamics and vessel wall remodeling patterns in middle cerebral artery (MCA) stenosis based on high-resolution magnetic resonance imaging and computational fluid dynamics (CFD). Methods Forty consecutive patients with recent ischemic stroke or transient ischemic attack attributed to unilateral atherosclerotic MCA stenosis (50–99%) were prospectively recruited. All patients underwent a cross-sectional scan of the stenotic MCA vessel wall. The parameters of the vessel wall, the number of patients with acute infarction, translesional wall shear stress ratio (WSSR), wall shear stress in stenosis (WSSs), and translesional pressure ratio were obtained. The patients were divided into positive remodeling (PR) and negative remodeling (NR) groups. The differences in vessel wall parameters and hemodynamics were compared. Correlations between the parameters of the vessel wall and hemodynamics were calculated. Results Of the 40 patients, 16 had PR, 19 had NR, and the other 5 displayed non-remodeling. The PR group had a smaller lumen area ( p = 0.004), larger plaque area ( p < 0.001), normal wall index ( p = 0.004), and higher WSSR ( p = 0.004) and WSSs ( p = 0.023) at the most narrowed site. The PR group had more enhanced plaques (12 vs 6, p = 0.03). The number of patients with acute stroke in the PR group was more than that in the NR group (11 vs 4, p = 0.01). The remodeling index ( r = 0.376, p = 0.026) and plaque area ( r = 0.407, p = 0.015) showed a positive correlation with WSSR, respectively. Conclusions Hemodynamics plays a role in atherosclerotic plaques and vessel wall remodeling. Individuals with greater hemodynamic values might be more prone to stroke. Key Points • Stenotic plaques in middle cerebral artery with positive remodeling have smaller lumen area and larger resp. higher plaque area, normal wall index, translesional wall shear stress ratio, and wall shear stress than negative remodeling. • The remodeling index and plaque area are positively correlated with translesional wall shear stress ratio. • Hemodynamic may help to understand the role of positive remodeling in the development of acute stroke.