Evidence mapPaperPMID 41669961Full record

ArticleJournal of the American Heart Association2026

High-Resolution Vessel Wall Imaging Can Differentiate Between Branch Atheromatous Disease From Small Vessel Ischemic Disease.

Farhan Khan, Eric Goldstein, Skylar Lewis, Jerrold L Boxerman, Karen Furie, Shadi Yaghi

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Article in Journal of the American Heart Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

6 authors.

Farhan Khan *Department of Neurology Brown University Providence RI USA.ORCID 0000-0002-5958-6881
Eric Goldstein *Department of Neurology Henry Ford Health System Clinton Township MI USA.ORCID 0000-0003-2297-495X
Skylar LewisDepartment of Neurology Brown University Providence RI USA.
Jerrold L BoxermanDepartment of Neuroradiology Brown University Providence RI USA.ORCID 0000-0002-0594-1542
Karen FurieDepartment of Neurology Brown University Providence RI USA.ORCID 0000-0003-0065-3784
Shadi YaghiDepartment of Neurology Brown University Providence RI USA.ORCID 0000-0003-0031-1004

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIschemic stroke in deep brain regions is commonly attributed to small vessel ischemic disease (SVID) or branch atheromatous disease (BAD). Differentiating these mechanisms is clinically important, as BAD is associated with progressive symptoms, early neurological deterioration, and poorer outcomes, whereas SVID typically follows a more stable course. Conventional imaging is limited in distinguishing these entities. High-resolution vessel wall imaging enables direct visualization of intracranial vessel wall pathology and may refine risk stratification.

methodsWe conducted a prospective, single-center study of patients with acute subcortical infarcts admitted between 2023 and 2025. Eligible patients underwent magnetic resonance imaging with high-resolution vessel wall imaging within 1 week of admission. SVID was defined as lacunar infarction without evidence of parent artery plaque or vessel wall enhancement. BAD was defined as infarction in the territory of a penetrating artery with associated parent artery enhancement. The primary outcome was differentiation of BAD from SVID based on vessel wall enhancement. Secondary outcomes included 90-day functional outcomes.

resultsOf 23 patients enrolled, 10 underwent magnetic resonance imaging with high-resolution vessel wall imaging. Vessel wall enhancement was observed in 5 patients (50%). Patients with enhancement were more often male (100% versus 40%) and had a higher prevalence of hyperlipidemia (100% versus 20%) compared with those without enhancement. Functional outcomes at 90 days were similar between the 2 groups.

conclusionsHigh-resolution vessel wall imaging can identify parent artery pathology not evident on conventional imaging, helping to distinguish BAD from SVID. This differentiation is clinically meaningful, as BAD may require more intensive secondary prevention. Larger studies are needed to validate these findings.

Indexed as

Brain IschemiaIschemic StrokeMagnetic Resonance ImagingPlaque, AtheroscleroticAgedDiagnosis, DifferentialFemaleHumansMaleMiddle AgedPredictive Value of TestsProspective Studiesbranch atheromatous diseaseischemic strokesingle subcortical infarctsmall vessel ischemic diseasevessel wall imaging

Identifiers

PMID41669961
PMCPMC13055658

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.