Intraplaque Enhancement Is Associated With Artery-to-Artery Embolism in Symptomatic Vertebrobasilar Atherosclerotic Diseases

Abstract

Objective: There are limited data regarding the characteristics of intracranial plaques according to stroke mechanism in the posterior circulation. This study aims to compare whether the plaque characteristics and baseline features are different in patients with artery-to-artery (A-to-A) embolism and those with parent artery disease in the intracranial vertebrobasilar atherosclerotic disease.Methods: From September 2014 to January 2017, patients with recent posterior circulation stroke due to intracranial vertebrobasilar atherosclerotic disease were retrospectively analyzed. Patients with the following eligibility criteria were included: (1) age ≥18 years old, (2) ischemic stroke in the vertebrobasilar territory, (3) 70–99% stenosis of the intracranial vertebral artery or basilar artery, and (4) two or more atherosclerotic risk factors. Patients with concomitant ipsilateral or bilateral extracranial vertebral artery >50% stenosis, cardio-embolism, or non-atherosclerotic stenosis were excluded. The plaque characteristics, including intraplaque compositions (intraplaque hemorrhage and intraplaque calcification), intraplaque enhancement, and remodeling index, were evaluated by using 3T high-resolution magnetic resonance imaging (HRMRI). The baseline features including vascular risk factors and the involved artery were collected. Patients were divided into A-to-A embolism and parent artery disease groups based on the diffusion-weighted images, T2-weighted images, or computed tomography. The plaque characteristics and baseline features were compared between the two groups.Results: Among consecutive 298 patients, 51 patients were included. Twenty-nine patients had A-to-A embolism and 22 patients had parent artery disease. Compared with parent artery disease, the occurrence rates of intraplaque enhancement and intracranial vertebral involvement were higher in the A-to-A embolism group (79.3 vs. 36.4%; p = 0.002 and 62.1 vs. 18.2%; p = 0.002, respectively). Multivariable logistic regression analysis showed that intraplaque enhancement and intracranial vertebral artery plaques were also associated with A-to-A embolism (adjusted OR, 7.31; 95% CI 1.58–33.77; p = 0.011 and adjusted OR, 9.42; 95% CI 1.91–46.50; p = 0.006, respectively).Conclusion: Intraplaque enhancement and intracranial vertebral artery plaques seem to be more closely associated with A-to-A embolism than parent artery disease in patients with symptomatic intracranial vertebrobasilar disease.Clinical Trial Registration:http://www.clinicaltrials.gov, identifier: NCT02705599.

A clinical-radiomics combined model based on carotid atherosclerotic plaque for prediction of ischemic stroke

“…The contrast agent enters and stays in the plaque through the loose endothelium, resulting in plaque vulnerability and different degrees of enhancement. Therefore, plaque enhancement is closely related to the occurrence of ischemic stroke events ( 41 , 42 ). However, it is interesting that the results of multivariate logistic regression analysis show that there is no statistically significant difference in plaque enhancement between the stroke group and the stroke-free group.…”

Emergent Large Vessel Occlusion due to Intracranial Stenosis: Identification, Management, Challenges, and Future Directions

“…17,32,33 On high-resolution vessel wall MRI of ICAS, artery-toartery embolism has been associated with plaque inflammation, surface irregularity, and rupture. 11,30,34 Because stroke severity is typically low for small embolic infarctions, the clinical presentation of artery-to-artery embolism is notable for low National Institutes of Health Stroke Scale scores and patients often have excellent recovery.…”

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

“…High-resolution vessel wall imaging (HR-VWI) has emerged as a useful tool for clinical research in recent years, which provides imaging-matched histopathologic information of ICAS in alive stroke patients. Notably, plaque imaging factors beyond the severity of luminal stenosis may not only portend a cerebral ischemic event, but also account for stroke patterns and clinical prognosis [8][9][10].…”