Intracranial Atherosclerotic Plaque Morphologic Pattern and Enhancement Change With High‐Intensity Statin Therapy

Background Plaque enhancement after gadolinium contrast administration may assess plaque instability and response to medical therapy. We used high‐resolution vessel wall imaging to evaluate changes in plaque morphologic pattern and enhancement after treatment with high‐intensity statins. Methods Patients with a history of stroke or transient ischemic attack attributable to intracranial atherosclerotic disease underwent 7‐T high‐resolution vessel wall imaging. T1 and T1+gadolinium sequences were obtained at baseline. Follow‐up images were acquired at a minimum of 6 months after the initial scan. Low‐density lipoprotein levels were also recorded at baseline and at follow‐up, after maximal medical therapy was started. Plaque burden, degree of stenosis, and area degree of stenosis were calculated at baseline and follow‐up. Gadolinium enhancement was quantified using a 3‐dimensional pipeline for plaque analysis. Results Five patients were included. The mean age was 56 years, and the average time to follow‐up imaging was 17.7 months. Low‐density lipoprotein decreased from a mean of 122 to 111 mg/dL at follow‐up. Plaque burden decreased from μ=76% to 60%, area degree of stenosis decreased from μ=61% to 56%, and gadolinium uptake decreased from a mean of μ=4.11 to 3.76. Furthermore, a lower low‐density lipoprotein at follow‐up was correlated with decreased plaque burden ( r =0.86), lower area degree of stenosis ( r =0.8), and less gadolinium uptake ( r =0.82). Conclusions Plaque morphologic pattern and gadolinium uptake changed at follow‐up with high‐intensity statin therapy. High‐resolution vessel wall imaging shows promise in assessing plaque response to medical therapy.