Characteristics of intracranial plaque in patients with non-cardioembolic stroke and intracranial large vessel occlusion

Abstract

ObjectiveTo determine the characteristics of intracranial plaque proximal to large vessel occlusion (LVO) in stroke patients without major-risk cardioembolic source using 3.0 T high-resolution MRI (HR-MRI).MethodsWe retrospectively enrolled eligible patients from January 2015 to July 2021. The multidimensional parameters of plaque such as remodelling index (RI), plaque burden (PB), percentage lipid-rich necrotic core (%LRNC), presence of discontinuity of plaque surface (DPS), fibrous cap rupture, intraplaque haemorrhage and complicated plaque were evaluated by HR-MRI.ResultsAmong 279 stroke patients, intracranial plaque proximal to LVO was more prevalent in the ipsilateral versus contralateral side to stroke (75.6% vs 58.8%, p<0.001). The larger PB (p<0.001), RI (p<0.001) and %LRNC (p=0.001), the higher prevalence of DPS (61.1% vs 50.6%, p=0.041) and complicated plaque (63.0% vs 50.6%, p=0.016) were observed in the plaque ipsilateral versus contralateral to stroke. Logistic analysis showed that RI and PB were positively associated with an ischaemic stroke (RI: crude OR: 1.303, 95% CI 1.072 to 1.584, p=0.008; PB: crude OR: 1.677, 95% CI 1.381 to 2.037, p<0.001). In subgroup with <50% stenotic plaque, the greater PB, RI, %LRNC and the presence of complicated plaque were more closely related to stroke, which was not evident in subgroup with ≥50% stenotic plaque.ConclusionThis is the first study to report the characteristics of intracranial plaque proximal to LVO in non-cardioembolic stroke. It provides potential evidence to support different aetiological roles of <50% stenotic vs ≥50% stenotic intracranial plaque in this population.

The value of coordinated analysis of multimodal atherosclerotic plaque imaging in the assessment of cardiovascular and cerebrovascular events

“…Several previous studies also demonstrated that culprit lesions had higher non-calcified plaque volume, large fibro-fatty (analyzing in coronary plaques only), and necrotic core volume ( 17 , 23 , 24 ). We found that the culprit plaque in coronary artery had larger FLPV and FPV than the non-event plaque, but the corresponding FLPR and FPR were not significantly different, so the difference in volume may be due to the culprit plaque having a larger volume.…”

Patterns and Implications of Intracranial Atherosclerosis in Anterior and Posterior Circulation Identified by High-Resolution Vessel Wall Imaging

“…Plaque hypo-intensity in ICAS serves as an imaging biomarker of intraplaque lipid core, and plaque contrast enhancement as intraplaque inflammation and neovascularization [19,20]. Both plaque imaging features provide potential clues to vulnerable plaques at high risk for rupture and future vascular ischemia [20,22,23]. We Values as medians (IQR) or numbers (%).…”

Predictors of positive remodeling in patients with acute ischemia stroke

“…HR-VWI has gained prominence for its ability to characterize high-risk plaques and determine stroke etiology [23][24][25] , however, the role of remodeling in ICAS and its clinical implications remain poorly defined. The varied remodeling patterns evident in the pathological progression of de novo atherosclerosis raise questions about the determinants of remodeling's extent and direction.…”