Purpose. To test possible relationship between the intensity of neoangiogenesis in the aortic wall in patients with resistant arterial hypertension, assessed by paramagnetic contrast enhancement (CE) MRI, and the subsequent development of ischemic cerebral disorders in them over a three-year follow-up.

Materials and methods. This study was retrospective and based on the data from the registry of complex MRI follow-up of patients with resistant arterial hypertension. It comprised 36 patients with resistant hypertension, in whom the radiofrequency ablation of the renal arteries (RFA) was carried out. All 36 were examined for 3 years after RFA using MRI of the brain and also with CE of the aorta and kidneys. Nine according to MRI data - developed an acute ischemic stroke during this period, and twenty seven had no cerebral circulation disorders. MRI studies included T2-w. and T1-w. spin-echo MRI, and also T1-w. MRI coronal slices, with suppression of the signal from adipose tissue (TR=150 ms, TE = 4 ms), before and in 12-15 minutes after PMCE (Optimark, Pro-hans), as 0.05 mM/kg of body weight. The diameter and thickness of the descending aorta wall were measured, and the T1-enhancement  index was calculated for the aortic wall, as ratio of intensities over the wall per voxel, after and before PMCE, as IE = (Int T1CE)/(Int T1pre-CE).

Results. After RFA the blood pressure significantly decreased in all patients for more than 15 mm Hg of systolic blood pressure. In groups of patients with ischemic stroke, and without it, the diameter of the aortic lumen at the level above the renal arteries was 22,1 ± 2,4 mm (n=9)  и 22,8 ± 2,7 mm (n = 27), respectively, the aortic wall thickness was 3.9 ± 0.7 mm (n=9) and 3.7 ± 0.8 mm (n = 27). In control subjects without AH (12 persons), the wall thickness was less than 2.7 mm (on average 2.2 ± 0.4 mm), with an aortic diameter of 21.3 ± 0.9.

As to index of aortic wall enhancement in CE MRI (as a marker of neovasculogenesis intensity) in  control group,  in everybody the IE was < 1.12. In patients with stroke within 3 years after RFA (n=9), IE = 2.12 ± 0.31, and in patients without stroke (n=27) IE = 1.66 ± 0.19. The value of IE =1.82 was the best for separating groups with and without stroke for three years, as from the ROC analysis.

Conclusion. Contrast enhancement of the aortic wall in CE-MRI is associated with the risk of brain ischemic stroke in patients with resistant arterial hypertension, even when blood pressure control is achieved by renal artery RFA. This makes possible to predict the risk of stroke in these patients more reliably, and encourages the inclusion of agents that reduce the activity of inflammation and pathological neoangiogenesis in the aortic wall, to spectrum of antihypertensive therapy.