Intracranial Atherosclerotic StenosisNCT07133451
Multimodal Imaging Evaluation of Vulnerability of Atherosclerotic Plaques: A Comparison of HR-VWI, OCT, and RWS
An observational study of Intracranial Atherosclerotic Stenosis, run by Shanghai Jiao Tong University Affiliated Sixth People's Hospital at 1 site in China.
Trial summary
The primary objective of this study is to evaluate the vulnerability of intracranial and extracranial atherosclerotic plaques using HR-VWI, OCT, and RWS technologies, while exploring correlations among these three imaging techniques. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Intracranial Atherosclerotic Stenosis
- How many people
- 561 participants
- Where
- 1 siteChina
- Study dates
- 10 Aug 2025to 30 Jun 2030
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: Patients with moderate to severe stenosis (stenosis degree: 70% ~ 99%) in both intracranial and extracranial arteries were considered for enrollment in this study.
Who may be able to join
- At least 18 years old;
- Severe stenosis of intracranial arteries (stenosis degree: 70% ~ 99%, traditional angiography is required to confirm the degree of stenosis according to the criteria of Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study);
- Carry out cerebral angiography and OCT within one week after HR-VWI examination;
- The patient or the legal representative of the patient is able and willing to sign an informed consent form.
Who cannot join
- Non-atherosclerotic intracranial and extracranial artery stenosis, such as dissection, smoke disease, etc.;
- There are contraindications to MRI, such as claustrophobia, metal implants, etc.; Renal insufficiency, elevated serum creatinine (more than twice the upper limit of normal);
- Patients with severe cardiopulmonary diseases were considered unsuitable for this study;
- Allergy to iodine or gadolinium contrast agent;
- Participants who were unable to complete the study due to mental illness, cognitive or emotional disorder.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
China1 site
Shanghai 6th People's Hospital
Shanghai, 200023
Yue-Qi Zhu, MD, 0086-021-64844183, zyq1111@126.com
Yue-Qi Zhu, MD
About this study
Official title: Prospective Cohort Registry Study on Multimodal Imaging Evaluation of Vulnerability of Intracranial and Extracranial Atherosclerotic Plaques: A Comparison of HR-VWI, OCT, and RWS
The primary objective of this study is to evaluate the vulnerability of intracranial and extracranial atherosclerotic plaques using HR-VWI, OCT, and RWS technologies, while exploring correlations among these three imaging techniques. Secondary objectives include: 1) Investigating the relationship between RWS and plaque progression and identifying optimal RWS predictors; 2) Further evaluating the clinical value of RWS and HR-VWI in stroke prediction through two-year clinical and HR-VWI follow-up evaluations.
Read the detailed description
Intracranial atherosclerotic stenosis (ICAS) is one of the leading causes of ischemic cerebrovascular disease worldwide, with an incidence rate as high as 46.6% among ischemic stroke or transient ischemic attacks (TIA) patients in China. Traditional arterial imaging techniques such as computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA) all provide lumen imaging capabilities. However, these methods can only reflect the severity of atherosclerotic lesions through vascular narrowing, failing to accurately assess the condition of the vessel wall.
High resolution magnetic resonance vessel wall imaging (HR-VWI) has enabled 2D and 3D imaging of intracranial arterial walls. This technique not only provides clear visualization of vascular morphology and signal characteristics, but also identifies plaque components, enhancement intensity, reconstruction type and load by suppressing intravascular blood flow. It also evaluates ICAS-prone plaque features such as intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and others. However, current HR-VWI scans face challenges including prolonged examination time, difficulties in aligning multiple sequences, and numerous contraindications (e.g., claustrophobia and pacemaker implantation). Additionally, image quality and effectiveness of intracranial artery HR-VWI are influenced by hardware/software parameters like magnetic field strength, receiving coils, imaging dimensions, sequences, and spatial resolution. These factors lead to variations across hospitals, with the absence of standardized protocols hindering standardized interpretation and analysis of images.
Optical Coherence Tomography (OCT), as an intravascular imaging technique, demonstrates high sensitivity and specificity in identifying different plaque components. With image resolution reaching 10μm - ten times that of conventional intravascular ultrasound- it has gained widespread recognition in coronary artery diagnosis and treatment. In recent years, OCT has also been applied in cerebral vascular interventional therapy, achieving notable progress in evaluating cerebral atherosclerotic plaques, performing interventional procedures, and conducting long-term follow-up studies.
Blood vessels are constantly subjected to biomechanical forces in the human body, including intraluminal arterial pressure and blood flow resistance. These mechanical forces induce dynamic strain and stress on vascular walls, which can trigger the rupture of atherosclerotic fibrous caps and inflammatory-prone plaques. High-resolution angiography can capture plaque strain or stress. Radial Wall Strain (RWS), a novel technique that utilizes high-resolution angiographic images and artificial intelligence to calculate plaque strain based on deformation patterns during different cardiac phases, has proven effective in coronary artery research. It demonstrates significant potential for risk stratification and prognosis prediction. Validation studies using OCT-defined plaque characteristics revealed that RWSmax shows a significant positive correlation with plaque lipid load and the lipid-fibrous cap ratio, while showing a significant negative correlation with cap thickness. A clinical cohort study employing propensity score matching evaluated the predictive power of angiography-based RWS for acute myocardial infarction (AMI) risk in newly diagnosed patients with mild-to-moderate coronary stenosis. Results indicated that RWSmax> 12% significantly increased the risk of AMI in untreated lesions by 7.25. Another study analyzed 1,318 delayed revascularization (DRV) vessels reported in the FAVOR III China main study. Vessels with RWSmax> 12% showed a 1-year vascular-derived composite endpoint event risk of 14.3%, compared to 2.9% for those ≤12% (risk ratio: 4.44). The research supports applying the novel RWS technology to assess residual risk in non-ischemic vessels defined by quantitative flow ratio (QFR), guiding necessary interventions such as intensified pharmacotherapy to enhance DRV safety. These findings indicate that RWS offers a novel decision-making model for coronary risk assessment and optimized management. Importantly, RWS can be calculated using routine single-slice angiographic images, eliminating the need for additional invasive procedures and demonstrating broad clinical applicability. However, its value in evaluating intracranial unstable plaques and their progression remains unverified. To address these technical advantages, this prospective clinical study aims to investigate RWS's efficacy in assessing intracranial plaque stability and progression risks, while comparing it with OCT and HR-VWI methods to evaluate feasibility and effectiveness.
- Conditions
- Intracranial Atherosclerotic Stenosis
- Keywords
- high resolution magnetic resonance imaging, intracranial atherosclerotic stenosis, atherosclerotic Plaques, radial Wall Strain, optical Coherence Tomography
- Medical subject headings
- Plaque, Atherosclerotic
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| Patients with moderate to severe stenosis (stenosis degree: 70% ~ 99%) in both intracranial and extr | Patients with moderate to severe stenosis (stenosis degree: 70% ~ 99%) in both intracranial and extracranial arteries were considered for enrollment in this study. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Diameter stenosis rate
According to the 3D TOF-MRA measurement of the lumen diameter at the narrowest part of the intracranial artery and the normal lumen diameter at the proximal end of the stenosis, the stenosis rate was calculated according to the WASID standard: diameter stenosis rate = [1- (the diameter at the narrowest part / the normal diameter at the proximal end of the stenosis)] × 100%
Measured: 2024.8-2027.12
Identify different plaque components
Measured: 2024.8-2027.12
OCT scanning scheme and image analysis
This study utilized the ILUMIEN OPTIS system (Abbott Medical, USA) to obtain frequency-domain OCT (FD-OCT) images. The procedure was performed under general anesthesia. Patients first underwent DSA cerebral angiography, after which a 6F long sheath (Epsylar, Opti Med, USA) was placed proximal to the lesion. A distal access catheter was introduced near the target lesion, and under fluoroscopy guidance, a micro guidewire was advanced through the lesion into the normal arterial lumen distally. The Dragonfly OPTIS imaging catheter (Abbott Medical, USA) was then exchanged for standard "single-track" entry, guiding it into the target vascular lesion. A mixed solution of physiological saline and iohexol contrast agent (GE Healthcare, Cork, Ireland), with a 1:1 concentration, was injected via the distal access catheter. OCT images were captured using automated retraction technology during blood clearance.
Measured: 2024.8-2027.12
RWS
Using single-position angiographic sequences, the cardiac cycle inference algorithm and automatic frame selection algorithm were applied to identify a key frame and multiple analysis frames with high image quality distributed across different phases of the same cardiac cycle. Subsequently, vascular segments of interest were defined on the key frame, and all corresponding matching segments were obtained through keypoint matching algorithms. The sub-pixel vascular contour segmentation algorithm was then used to generate detailed vessel outlines and calculate radial diameters for all analysis frames. Based on multi-frame vascular contours and diameter data, an automatic 2D point cloud registration algorithm was employed to determine radial alignment relationships between vascular segments. Finally, relative radial deformation was calculated using these alignment relationships and diameter information to derive RWS variation curves.
Measured: 2024.8-2027.12
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted21 Aug 2025
- Study start10 Aug 2025 (estimated)
- Primary completion31 Dec 2028 (estimated)
- Study completion30 Jun 2030 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Intracranial Atherosclerotic StenosisStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 561 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Yueqi Zhu, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
- Investigators
- Yueqi Zhu, MD, Principal investigator, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07133451
- Sponsor's protocol ID
- Plaque-MAGIC Study
- Status last verified
- Aug 2025
- First submitted
- 6 Aug 2025
- Last updated
- 21 Aug 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 21 Aug 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Prospective Cohort Registry Study on Multimodal Imaging Evaluation of Vulnerability of Intracranial and Extracranial Atherosclerotic Plaques: A Comparison of HR-VWI, OCT, and RWS
- ClinicalTrials.gov ID
- NCT07133451
- Acronym / sponsor ID
- Plaque-MAGIC Study
- Conditions
- Intracranial Atherosclerotic Stenosis
- Keywords
- high resolution magnetic resonance imaging, intracranial atherosclerotic stenosis, atherosclerotic Plaques, radial Wall Strain, optical Coherence Tomography
- Study type
- Observational
- Recruitment status
- Not yet recruiting
- Enrolment
- 561 participants (estimated)
- Lead sponsor
- Shanghai Jiao Tong University Affiliated Sixth People's HospitalUniversity, hospital or other
- Study start
- 10 Aug 2025 (estimated)
- Primary completion
- 31 Dec 2028 (estimated)
- Study completion
- 30 Jun 2030 (estimated)
- First posted
- 21 Aug 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The primary objective of this study is to evaluate the vulnerability of intracranial and extracranial atherosclerotic plaques using HR-VWI, OCT, and RWS technologies, while exploring correlations among these three imaging techniques. Secondary objectives include: 1) Investigating the relationship between RWS and plaque progression and identifying optimal RWS predictors; 2) Further evaluating the clinical value of RWS and HR-VWI in stroke prediction through two-year clinical and HR-VWI follow-up evaluations.
Detailed description
Intracranial atherosclerotic stenosis (ICAS) is one of the leading causes of ischemic cerebrovascular disease worldwide, with an incidence rate as high as 46.6% among ischemic stroke or transient ischemic attacks (TIA) patients in China. Traditional arterial imaging techniques such as computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA) all provide lumen imaging capabilities. However, these methods can only reflect the severity of atherosclerotic lesions through vascular narrowing, failing to accurately assess the condition of the vessel wall.
High resolution magnetic resonance vessel wall imaging (HR-VWI) has enabled 2D and 3D imaging of intracranial arterial walls. This technique not only provides clear visualization of vascular morphology and signal characteristics, but also identifies plaque components, enhancement intensity, reconstruction type and load by suppressing intravascular blood flow. It also evaluates ICAS-prone plaque features such as intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and others. However, current HR-VWI scans face challenges including prolonged examination time, difficulties in aligning multiple sequences, and numerous contraindications (e.g., claustrophobia and pacemaker implantation). Additionally, image quality and effectiveness of intracranial artery HR-VWI are influenced by hardware/software parameters like magnetic field strength, receiving coils, imaging dimensions, sequences, and spatial resolution. These factors lead to variations across hospitals, with the absence of standardized protocols hindering standardized interpretation and analysis of images.
Optical Coherence Tomography (OCT), as an intravascular imaging technique, demonstrates high sensitivity and specificity in identifying different plaque components. With image resolution reaching 10μm - ten times that of conventional intravascular ultrasound- it has gained widespread recognition in coronary artery diagnosis and treatment. In recent years, OCT has also been applied in cerebral vascular interventional therapy, achieving notable progress in evaluating cerebral atherosclerotic plaques, performing interventional procedures, and conducting long-term follow-up studies.
Blood vessels are constantly subjected to biomechanical forces in the human body, including intraluminal arterial pressure and blood flow resistance. These mechanical forces induce dynamic strain and stress on vascular walls, which can trigger the rupture of atherosclerotic fibrous caps and inflammatory-prone plaques. High-resolution angiography can capture plaque strain or stress. Radial Wall Strain (RWS), a novel technique that utilizes high-resolution angiographic images and artificial intelligence to calculate plaque strain based on deformation patterns during different cardiac phases, has proven effective in coronary artery research. It demonstrates significant potential for risk stratification and prognosis prediction. Validation studies using OCT-defined plaque characteristics revealed that RWSmax shows a significant positive correlation with plaque lipid load and the lipid-fibrous cap ratio, while showing a significant negative correlation with cap thickness. A clinical cohort study employing propensity score matching evaluated the predictive power of angiography-based RWS for acute myocardial infarction (AMI) risk in newly diagnosed patients with mild-to-moderate coronary stenosis. Results indicated that RWSmax> 12% significantly increased the risk of AMI in untreated lesions by 7.25. Another study analyzed 1,318 delayed revascularization (DRV) vessels reported in the FAVOR III China main study. Vessels with RWSmax> 12% showed a 1-year vascular-derived composite endpoint event risk of 14.3%, compared to 2.9% for those ≤12% (risk ratio: 4.44). The research supports applying the novel RWS technology to assess residual risk in non-ischemic vessels defined by quantitative flow ratio (QFR), guiding necessary interventions such as intensified pharmacotherapy to enhance DRV safety. These findings indicate that RWS offers a novel decision-making model for coronary risk assessment and optimized management. Importantly, RWS can be calculated using routine single-slice angiographic images, eliminating the need for additional invasive procedures and demonstrating broad clinical applicability. However, its value in evaluating intracranial unstable plaques and their progression remains unverified. To address these technical advantages, this prospective clinical study aims to investigate RWS's efficacy in assessing intracranial plaque stability and progression risks, while comparing it with OCT and HR-VWI methods to evaluate feasibility and effectiveness.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Patients with moderate to severe stenosis (stenosis degree: 70% ~ 99%) in both intracranial and extr | – | –Patients with moderate to severe stenosis (stenosis degree: 70% ~ 99%) in both intracranial and extracranial arteries were considered for enrollment in this study. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Patients with moderate to severe stenosis (stenosis degree: 70% ~ 99%) in both intracranial and extracranial arteries were considered for enrollment in this study.
Key inclusion criteria (4 listed)
- At least 18 years old;
- Severe stenosis of intracranial arteries (stenosis degree: 70% ~ 99%, traditional angiography is required to confirm the degree of stenosis according to the criteria of Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study);
- Carry out cerebral angiography and OCT within one week after HR-VWI examination;
- The patient or the legal representative of the patient is able and willing to sign an informed consent form.
Key exclusion criteria (5 listed)
- Non-atherosclerotic intracranial and extracranial artery stenosis, such as dissection, smoke disease, etc.;
- There are contraindications to MRI, such as claustrophobia, metal implants, etc.; Renal insufficiency, elevated serum creatinine (more than twice the upper limit of normal);
- Patients with severe cardiopulmonary diseases were considered unsuitable for this study;
- Allergy to iodine or gadolinium contrast agent;
- Participants who were unable to complete the study due to mental illness, cognitive or emotional disorder.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Diameter stenosis rate
Time frame: 2024.8-2027.12
According to the 3D TOF-MRA measurement of the lumen diameter at the narrowest part of the intracranial artery and the normal lumen diameter at the proximal end of the stenosis, the stenosis rate was calculated according to the WASID standard: diameter stenosis rate = [1- (the diameter at the narrowest part / the normal diameter at the proximal end of the stenosis)] × 100%
Identify different plaque components
Time frame: 2024.8-2027.12
OCT scanning scheme and image analysis
Time frame: 2024.8-2027.12
This study utilized the ILUMIEN OPTIS system (Abbott Medical, USA) to obtain frequency-domain OCT (FD-OCT) images. The procedure was performed under general anesthesia. Patients first underwent DSA cerebral angiography, after which a 6F long sheath (Epsylar, Opti Med, USA) was placed proximal to the lesion. A distal access catheter was introduced near the target lesion, and under fluoroscopy guidance, a micro guidewire was advanced through the lesion into the normal arterial lumen distally. The Dragonfly OPTIS imaging catheter (Abbott Medical, USA) was then exchanged for standard "single-track" entry, guiding it into the target vascular lesion. A mixed solution of physiological saline and iohexol contrast agent (GE Healthcare, Cork, Ireland), with a 1:1 concentration, was injected via the distal access catheter. OCT images were captured using automated retraction technology during blood clearance.
RWS
Time frame: 2024.8-2027.12
Using single-position angiographic sequences, the cardiac cycle inference algorithm and automatic frame selection algorithm were applied to identify a key frame and multiple analysis frames with high image quality distributed across different phases of the same cardiac cycle. Subsequently, vascular segments of interest were defined on the key frame, and all corresponding matching segments were obtained through keypoint matching algorithms. The sub-pixel vascular contour segmentation algorithm was then used to generate detailed vessel outlines and calculate radial diameters for all analysis frames. Based on multi-frame vascular contours and diameter data, an automatic 2D point cloud registration algorithm was employed to determine radial alignment relationships between vascular segments. Finally, relative radial deformation was calculated using these alignment relationships and diameter information to derive RWS variation curves.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 21 Aug 2025.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Yueqi Zhu, MD principal investigator
Shanghai Jiao Tong University Affiliated Sixth People's Hospital
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Intracranial Atherosclerotic Stenosis, run by Shanghai Jiao Tong University Affiliated Sixth People's Hospital at 1 site in China.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 21 Aug 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Yueqi Zhu, MD (0086-21-64844183, zhuyueqi@hotmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Diameter stenosis rate (time frame: 2024.8-2027.12). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Aug 2025.