Correlation of the characteristics of symptomatic intracranial atherosclerotic plaques with stroke types and risk of stroke recurrence: a cohort study

Abstract

Background: Symptomatic intracranial atherosclerotic stenosis (sICAS) patients had a higher risk of stroke recurrence, and the risk of acute ischemic stroke (AIS) was higher than transient ischemic attack (TIA).Therefore, it is important to explore the risk factors associated with sICAS clinical subtypes and the risk of stroke recurrence. The purpose of this study was to investigate the association between intracranial arterial culprit plaque characteristics with sICAS clinical subtypes and the risk of stroke recurrence.Methods: A total of 206 patients with sICAS were included. Baseline demographic data and relevant serologic indices were collected from all participants. All participants were assessed by high-resolution vessel wall imaging (HR-VWI) for culprit vessel and culprit plaque characteristics. The follow-up method was outpatient or telephone follow-up. Associated factors for sICAS clinical subtypes were analyzed by binary logistic regression. Cox proportional hazard regression analysis were used to analysis the independent risk factors for recurrent stroke.Results: In this group, there were 154 patients with AIS, 52 patients with TIA, 124 patients with anterior circulation ischemic symptom (ACiS), and 82 patients with posterior circulation ischemic symptom (PCiS).Male gender [odds ratio (OR) =5.575, 95% confidence interval (CI): 2.120 to 14.658], history of previous statin use (OR =0.309, 95% CI: 0.113 to 0.843) and serum apolipoprotein A/B values (OR =0.363, 95% CI: 0.139 to 0.948) were associated factors for AIS. A total of 24 patients (11.7%) experienced stroke recurrence during the 1-year follow-up period. Hyperintensity on T1 weighted imaging (T1WI) in the culprit plaque [hazard ratio (HR) =3.798, 95% CI: 1.433 to 10.062] was an independent risk factor for stroke recurrence.The incidence of significant enhancement (62.2% vs. 39.5%, χ 2 =9.681, P=0.002), positive remodeling (69.5% vs. 52.4%, χ 2 =5.661, P=0.020), and hyperintensity on T1WI (42.7% vs. 22.6%, χ 2 =16.472, P=0.003) was higher in the posterior circulation than in the anterior circulation.Conclusions: The characteristics of intracranial arterial culprit plaques were independent risk factors for recurrent stroke, and there were differences in the plaque characteristics of anterior and posterior circulation.Early HR-VWI examination for sICAS patients is of great significance for patient risk stratification and personalized management.

Refined imaging features of culprit plaques improve the prediction of recurrence in intracranial atherosclerotic stroke within the middle cerebral artery territory

“…The inclusion criteria for patient enrollment were as follows: (1) first onset of stroke within 4 weeks of HR-MR-VWI ( Ran et al, 2020 , Jiang et al, 2022 ); (2) acute IS within the unilateral MCA territory as observed on diffusion-weighted imaging (DWI); (3) presence of at least one cardiovascular disease risk factor: hypertension, diabetes mellitus, hyperlipidemia, hyperhomocysteinemia, smoking and/or drinking habits ( Song et al, 2020 , Jiang et al, 2022 ); (4) age of 18 years or older. The exclusion criteria were as follows: (1) presence of chronic IS or transient ischemic attack (TIA); (2) culprit vessel other than the ipsilateral MCA; (3) ipsilateral carotid artery stenosis ≥ 50% ( Song et al, 2020 , Xu et al, 2022 ); (4) patients with infarcts in multiple artery territories beyond MCA ( Li et al, 2021 ).…”

“…The NIHSS score was used to assess the degree of neurological impairment and short-term outcome. Stroke recurrence was diagnosed when a new lesion exhibiting hyperintensity on DWI and hypointensity on apparent diffusion coefficient (ADC) images within the MCA territory was observed on follow-up MR examination, accompanied by corresponding neurological dysfunction ( Jiang et al, 2022 ). The patient with transit stroke symptoms without new infarction lesion on MRI was diagnosed as TIA instead of IS recurrence.…”

“…The presence of mild enhancement of the plaque was considered when the signal intensity of the plaque was lower than that of the pituitary stalk after contrast medium injection. Mild and obvious enhancement were defined when the signal intensity of the culprit plaque were weaker, and equal to or higher than that of the pituitary stalk on post-contrast HR-MR-VWI separately ( Jiang et al, 2022 , Ren et al, 2023 ). For the cases with IPH, a subtraction imaging between post- contrast and non-contrast HR-MR-VWI was made for judging true enhancement ( Fig.…”

“…3 ). Intraplaque hemorrhage was defined as high signal intensity within the plaque that was more than 150% of the adjacent muscle signal intensity on pre-contrast HR-MR-VWI ( Jiang et al, 2022 ). The presence of a discontinuous surface of the plaque adjacent to the lumen was considered an irregularity of the plaque ( Wu et al, 2018 ).…”

High-resolution magnetic resonance vessel wall imaging in ischemic stroke and carotid artery atherosclerotic stenosis: A review

“…Recently, Wu XB et al used HR-VWI combined with hemodynamic indicators to analyze the relationship with ischemic stroke, and found that plaque enhancement and wall shear stress ratio were significantly associated with ischemic stroke [ 113 ]. This demonstrates the remarkable contributions of HR-VWI in improving patient outcomes and directing tailored interventions for ischemic stroke [ 94 , [114] , [115] , [116] ].…”