Intracranial ICAs Most Affected by Atherosclerosis in CREST-H; Contralateral Pairs Co-occur

In CREST-H, intracranial atherosclerotic disease was most prevalent in ICAs (69% right, 67% left). Significant pairwise associations linked contralateral ICA, PCA, ACA (p<0.001) and right ICA–ACA (φ=0.25). Left ICA–ACA was not significant. Retrospective TOF-MRA analysis.

• Retrospective analysis of 252 CREST-H trial patients with baseline TOF-MRA; circle of Willis completeness: 17.5% complete, 73.8% partially complete, 8.7% fully incomplete.
• Contralateral segment pairs (ICA, PCA, ACA) all showed significant associations (all p<0.001), while right ICA–right ACA also associated (φ=0.25, p<0.001).
• Limitations: TOF-MRA used as luminal surrogate rather than direct plaque imaging; retrospective, single-cohort design limits generalizability.

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