MRI-derived Pressure Ratio (MPR) to predict stroke risk in intracranial atherosclerosis (ICAS)

MRI-Derived Pressure Ratio: a Novel Noninvasive Hemodynamic Biomarker for Stroke Risk Stratification in Intracranial Atherosclerotic Stenosis

This study will test whether a new MRI-derived pressure ratio (MPR) can help predict 1-year stroke risk in adults (18–80) with 50–99% intracranial atherosclerotic stenosis in the anterior circulation.

Quick facts

• Study type: Observational
• Enrollment: 400 (estimated)
• Ages: 18 Years to 80 Years
• Sex: All
• Sponsor: Xuanwu Hospital, Beijing (other)
• Locations: 1 site (Beijing, Xicheng District)
• Trial ID: NCT07309718 on ClinicalTrials.gov

What this trial studies

This is a multicenter prospective single-arm registry enrolling 400 consecutive adults with symptomatic anterior-circulation ICAS and 50–99% stenosis. All participants receive standardized medical therapy per AHA/ASA guidelines and undergo multimodal imaging including TCD, CTA/MRA/DSA, high-resolution MRI, and phase-contrast MRA to calculate MPR. Participants are followed at baseline, 1 month, 6 months, and 12 months, with the primary outcome of ischemic stroke in the qualifying artery territory or related death within one year. An independent DSMB oversees safety and study conduct across five participating stroke centers coordinated by Xuanwu Hospital in Beijing.

Who should consider this trial

Good fit: Adults aged 18–80 with symptomatic anterior-circulation intracranial atherosclerotic stenosis of 50–99% who can undergo MRI and give informed consent are the ideal candidates.

Not a fit: Patients with non-atherosclerotic intracranial disease, large baseline infarcts or baseline disability (mRS ≥3), contraindications to MRI, or significant ipsilateral extracranial carotid stenosis are unlikely to benefit from MPR measurement in this protocol.

Why it matters

Potential benefit: If successful, MPR could help doctors identify which patients with ICAS are at higher short-term stroke risk and guide more personalized prevention strategies.

How similar studies have performed: Pressure-based hemodynamic approaches are well established in coronary disease and have shown promise in limited neurovascular research, but MPR as an MRI-derived intracranial pressure ratio is a relatively novel application with limited prior large-scale validation.

Eligibility criteria

Inclusion Criteria:

1. Adults aged 18 to 80 years.
2. Intracranial atherosclerotic stenosis ICAS involving a culprit artery in the anterior circulation.
3. Intracranial arterial stenosis of 50% to 99% as measured by the WASID method using TCD, CTA, MRA, or DSA.
4. Written informed consent obtained from the participant or a legal representative.

Exclusion Criteria:

1. Non-atherosclerotic intracranial lesions, including moyamoya disease, vasculitis, vascular dissection, autoimmune diseases, or congenital/genetic abnormalities.
2. More than 50% stenosis of the extracranial carotid artery on the ipsilateral side.
3. Large cerebral infarction involving more than one-half of the territory on DWI imaging, or a baseline modified Rankin Scale score ≥3.
4. Contraindications to antiplatelet therapy or statins.
5. Inability to undergo MRI due to metal implants or claustrophobia.

Where this trial is running

Beijing, Xicheng District

• Department of Neurosurgery, Xuanwu hospital — Beijing, Xicheng District, China (RECRUITING)

Study contacts

• Study coordinator: Jichang Luo, M.D.

Conditions: ICAS - Intracranial Atherosclerosis, Stroke Ischemic, Hemodynamic, Pressure ratio