Co-existing cerebrovascular atherosclerosis predicts subsequent vascular event: a multi-contrast cardiovascular magnetic resonance imaging study

Abstract

Background: It is still unknown that whether co-existing intracranial stenosis and extracranial carotid vulnerable plaques have higher predictive value for subsequent vascular events. This study aimed to determine the relationship between co-existing extracranial carotid vulnerable plaques and intracranial stenosis and subsequent vascular events utilizing cardiovascular magnetic resonance (CMR) vessel wall imaging. Methods: Patients who had recent cerebrovascular symptoms in anterior circulation (< 2 weeks) were consecutively enrolled and underwent multi-contrast CMR vessel wall imaging for extracranial carotid arteries and 3D time-of flight CMR angiography for intracranial arteries at baseline. After baseline examination, all patients were followed-up for at least 1 year to determined recurrence of vascular events. The co-existing cerebrovascular atherosclerosis was defined as presence of both intracranial artery stenosis and at least one the following measures of extracranial artery atherosclerosis: plaque, calcification, lipid-rich necrotic core (LRNC), or intraplaque hemorrhage. Univariate and multivariate Cox regressions were used to calculate the hazard ratio (HR) and corresponding 95% confidence interval (CI) of co-existing plaques in predicting subsequent vascular events. Results: In total, 150 patients (mean age: 61.8 ± 11.9 years; 109 males) were recruited. During the median follow-up time of 12.1 months, 41 (27.3%) patients experienced vascular events. Co-existing intracranial artery stenosis and extracranial carotid plaque (HR, 3.57; 95% CI, 1.63-7.82; P = 0.001) and co-existing intracranial artery stenosis and extracranial carotid LRNC (HR, 4.47; 95% CI,; P < 0.001) were significantly associated with subsequent vascular events, respectively. After adjusted for confounding factors and carotid stenosis, these associations remained statistically significant (HR, 5.12; 95% CI, 1.36-19.24; P = 0.016 and HR, 8.12; 95% CI, 2.41-27.31; P = 0.001, respectively). Conclusions: The co-existing cerebrovascular atherosclerotic diseases, particularly co-existing carotid lipid-rich necrotic core and intracranial stenosis, are independent predictors for subsequent vascular events.

Intracranial Atherosclerotic Plaque Characteristics and Burden Associated With Recurrent Acute Stroke: A 3D Quantitative Vessel Wall MRI Study

“…Also, the use of 3D black blood MRI can potentially detect more plaques without stenosis than DSA (up to 27% more by a recent study) (Tian et al, 2021 ). Recent 3D MR-VWI studies showed that the total plaque number involving both the symptomatic intracranial and extracranial arteries had a strong predictive value for recurrent stroke (Xu et al, 2016 ; Li et al, 2020 ). Compared to previous studies, our study with 3D MR-VWI evaluated the entire cerebral vasculature out to the second-order branches, rather than only the symptomatic arterial territory; our approach enriched the existing evidence that multiple intracranial plaques are related to stroke recurrence.…”

“…Many large prospective studies have documented that the presence of multiple intracranial atherosclerotic stenoses (ICAS) or concurrent extracranial atherosclerosis, on computed tomography angiography (CTA) (Lau et al, 2013 ), magnetic resonance angiography (MRA) (Man et al, 2009 ; Wang et al, 2014 ; Sun et al, 2018 ), or digital subtraction angiography (DSA) (Zhao et al, 2018 ), was an independent predictor of stroke recurrence. Coexisting cerebrovascular atherosclerosis involving both intracranial and extracranial arterial beds is an independent predictor for subsequent vascular events (including ischemic stroke) (Li et al, 2020 ).…”

Progression of Plaque Burden of Intracranial Atherosclerotic Plaque Predicts Recurrent Stroke/Transient Ischemic Attack: A Pilot Follow‐Up Study Using Higher‐Resolution MRI

“…[5][6][7][8][9] However, most of these studies were cross sectional and there has been little investigation into the prognostic value of HR-MRI. 10,11 In addition, a previous study investigating changes in plaque features over time and their relationship to recurrent stroke was limited by small sample size (N < 15). 12 Thus, the aim of this study was 1) to investigate the prognostic value of intracranial atherosclerotic plaque features in predicting recurrent cerebrovascular ischemic events using HR-MRI in acute stroke patients and 2) to evaluate the temporal changes of plaque features and study their relationship to recurrent ischemic events.…”

“… 5 , 6 , 7 , 8 , 9 However, most of these studies were cross sectional and there has been little investigation into the prognostic value of HR‐MRI. 10 , 11 In addition, a previous study investigating changes in plaque features over time and their relationship to recurrent stroke was limited by small sample size ( N < 15). 12 …”

Concurrent intracranial and extracranial artery stenosis and the prognosis of transient ischaemic symptoms or imaging-negative ischaemic stroke

“…A previous study found that the coexistence of intracranial artery stenosis and the extracranial lipid-rich necrotic core was associated with a higher risk of subsequent vascular events. 18 We aimed to test the hypothesis that concurrent intracranial atherosclerotic stenosis (ICAS) and extracranial atherosclerotic stenosis (ECAS) might increase the risk of stroke recurrence and composite vascular events in patients with transient ischaemic symptoms or AIS with negative DWI.…”