Mechanisms of early Recurrence in Intracranial Atherosclerotic Disease (MyRIAD): Rationale and design

J Stroke Cerebrovasc Dis. 2020 Oct;29(10):105051. doi: 10.1016/j.jstrokecerebrovasdis.2020.105051. Epub 2020 Jul 11.


Rationale: Intracranial atherosclerotic disease (ICAD) is the most common cause of ischemic stroke with the highest rate of recurrence, despite aggressive medical management. Diverse mechanisms may be responsible for ICAD-related cerebral ischemia, with potential therapeutic implications. Here we present the rationale, design and methods of the Mechanisms of Early Recurrence in Intracranial Atherosclerotic Disease (MyRIAD) study. The aim of MyRIAD is to determine the mechanisms of stroke in ICAD through physiologic imaging biomarkers that evaluate impaired antegrade flow, poor distal perfusion, abnormal vasoreactivity, artery to artery embolism, and their interaction.

Methods and design: This is a prospective observational study of patients with recently symptomatic (<21 days) ICAD with 50-99% stenosis treated medically and monitored for up to 1 year. An estimated 110 participants are recruited at 10 sites to identify the association between the presence of each mechanism of ischemia and recurrent stroke. The primary outcome is ischemic stroke in the territory of the symptomatic artery. Secondary outcomes include new cerebral infarction on MRI at 6-8 weeks and recurrent TIA in the territory of the symptomatic artery.

Discussion: MyRIAD is positioned to define the role of specific mechanisms of recurrent ischemia in patients with symptomatic ICAD. This knowledge will allow the development and implementation of effective and specific treatments for this condition.

Keywords: Biomarkers; Intracranial arterial disease; Research design; Stroke.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Brain Infarction / diagnostic imaging
  • Brain Infarction / etiology*
  • Brain Infarction / physiopathology
  • Brain Infarction / therapy
  • Cerebrovascular Circulation*
  • Female
  • Humans
  • Intracranial Arteriosclerosis / complications
  • Intracranial Arteriosclerosis / diagnostic imaging*
  • Intracranial Arteriosclerosis / physiopathology
  • Intracranial Arteriosclerosis / therapy
  • Ischemic Attack, Transient / diagnostic imaging
  • Ischemic Attack, Transient / etiology*
  • Ischemic Attack, Transient / physiopathology
  • Ischemic Attack, Transient / therapy
  • Magnetic Resonance Angiography*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Recurrence
  • Research Design*
  • Risk Factors
  • Time Factors
  • Ultrasonography, Doppler, Transcranial*