Predictive value of the combination between the intracranial arterial culprit plaque characteristics and the Essen Stroke Risk Score for short-term stroke recurrence

Ren, Kaixuan; Jiang, Huayun; Li, Tiantian; Qian, Chengqun; Gong, Shenchu; Wang, Tianle; Zhu, Li

doi:10.1016/j.jstrokecerebrovasdis.2022.106624

Cited by 11 publications

(11 citation statements)

References 24 publications

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“…Previous studies about the relationship between stroke recurrence and plaque enhancement are inconsistent, which needs to be addressed. [9][10][11] In conclusion, our study shows IPH is significantly associated with recurrent ipsilateral stroke, suggesting its potential value in the selection of patients for aggressive treatment strategies in the future.…”

Section: Discussionmentioning

confidence: 90%

“…However, it should be noted that inconsistency in the relationship between IPH and stroke recurrence has been reported. [9][10][11] These discrepancies could be attributed to the lack of fat-suppressed techniques and small sample size in previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…plaque enhancement, plaque burden, and IPH) have been demonstrated to be related with the occurrence and recurrence of the stroke. [6][7][8][9][10][11] However, these associations were not consistent across studies and remained elusive, possibly due to variance in study design, sample size and imaging protocols. [6][7][8][9][10][11] There is a need for a multicenter, large-sample, prospective cohort study with a unified imaging protocol to validate these findings.…”

Section: Introductionmentioning

confidence: 99%

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Association between high-resolution magnetic resonance vessel wall imaging characteristics and recurrent stroke in patients with intracranial atherosclerotic steno-occlusive disease: A prospective multicenter study

Yuan,

Liu,

Yan

et al. 2024

International Journal of Stroke

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Background: High-resolution magnetic resonance vessel wall imaging (HRMR-VWI) is a promising technique for identifying intracranial vulnerable plaques beyond lumen narrowing. However, the association between HRMR-VWI characteristics and recurrent stroke remains uncertain. Aims: This study aimed to investigate the association between HRMR-VWI characteristics and recurrent ipsilateral stroke in patients with symptomatic intracranial atherosclerotic steno-occlusive disease (ICAS). Methods: This multicenter, observational study recruited first-ever acute ischemic stroke patients attributed to ICAS (>50% stenosis or occlusion) within 7 days after onset. Participants were assessed by multi-parametric MRI including diffusion-weighted imaging, three-dimension time-of-flight magnetic resonance angiography, and three-dimensional T1-weighted HRMR-VWI. The patients were recommended to receive best medical therapy and were systematically followed up for 12 months. The association between HRMR-VWI characteristics and the time to recurrent ipsilateral stroke was investigated by univariable and multivariable analysis. Results: Two hundred and fifty-five consecutive patients were enrolled from 15 centers. The cumulative 12-month ipsilateral recurrence incidence was 4.1% (95% confidence interval [CI]: 1.6-6.6%). Patients with recurrent ipsilateral stroke exhibited higher rates of intraplaque hemorrhage (IPH) (30.0% vs. 6.5%) and eccentric plaque (90.0% vs. 48.2%), and lower occurrence of occlusive thrombus (10.0% vs. 23.7%). Plaque length (5.69±2.21 mm vs. 6.67±4.16 mm), plaque burden (78.40±7.37% vs. 78.22±8.32%), degree of stenosis (60.25±18.95% vs. 67.50±22.09%) and remodeling index (1.07±0.27 vs. 1.03±0.35) on HRMR-VWI did not differ between patients with and without recurrent ipsilateral stroke. In the multivariable Cox regression analysis, IPH (hazard ratio: 6.64, 95% CI: 1.23-35.8, p=0.028) was significantly associated with recurrent ipsilateral stroke after adjustment. Conclusions: Our results suggest IPH is significantly associated with recurrent ipsilateral stroke and has potential value in the selection of patients for aggressive treatment strategies. Data access statement: Data from this study is available and can be accessed upon request.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association between high-resolution magnetic resonance vessel wall imaging characteristics and recurrent stroke in patients with intracranial atherosclerotic steno-occlusive disease: A prospective multicenter study

Yuan,

Liu,

Yan

et al. 2024

International Journal of Stroke

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“…Based on the SHAP plots, the model indicates that certain factors, namely the plaque stenosis rate, intraplaque hemorrhage, enhancement grade, and normalized wall index (NWI), are strong predictors of recurrent stroke in SICAS, consistent with previous studies. Ren et al (2022) demonstrated the significant impact of plaque stenosis rate on stroke recurrence. From a hemodynamic perspective, plaque stenosis correlates negatively with perfusion in distant brain tissue and blood flow velocity.…”

Section: Discussionmentioning

confidence: 96%

An interpretable machine learning model for stroke recurrence in patients with symptomatic intracranial atherosclerotic arterial stenosis

Gao,

Li,

Zhai

et al. 2024

Front. Neurosci.

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Background and objectiveSymptomatic intracranial atherosclerotic stenosis (SICAS) is the most common etiology of ischemic stroke and one of the main causes of high stroke recurrence. The recurrence of stroke is closely related to the prognosis of ischemic stroke. This study aims to develop a machine learning model based on high-resolution vessel wall imaging (HR-VWI) to predict the risk of stroke recurrence in SICAS.MethodsThis study retrospectively collected data from 180 SICAS stroke patients treated at the hospital between 2020.01 and 2022.01. Relevant imaging and clinical data were collected, and follow-up was conducted. The dataset was divided into a training set and a validation set in a ratio of 7:3. We employed the least absolute shrinkage and selection operator (LASSO) regression to perform a selection on the baseline data, laboratory tests, and neuroimaging data generated by HR-VWI scans collected from the training set. Finally, five machine learning techniques, including logistic regression model (LR), support vector machine (SVM), Gaussian naive Bayes (GNB), Complement naive Bayes (CNB), and k-nearest neighbors algorithm (kNN), were employed to develop a predictive model for stroke recurrence. Shapley Additive Explanation (SHAP) was used to provide visualization and interpretation for each patient. The model’s effectiveness was evaluated using average accuracy, sensitivity, specificity, precision, f1 score, PR curve, calibration curve, and decision curve analysis.ResultsLASSO analysis revealed that “history of hypertension,” “homocysteine level,” “NWI value,” “stenosis rate,” “intracranial hemorrhage,” “positive remodeling,” and “enhancement grade” were independent risk factors for stroke recurrence in SICAS patients. In 10-fold cross-validation, the area under the curve (AUC) ranged from 0.813 to 0.912 in ROC curve analysis. The area under the precision-recall curve (AUPRC) ranged from 0.655 to 0.833, with the Gaussian Naive Bayes (GNB) model exhibiting the best ability to predict stroke recurrence in SICAS. SHAP analysis provided interpretability for the machine learning model and revealed essential factors related to the risk of stroke recurrence in SICAS.ConclusionA precise machine learning-based prediction model for stroke recurrence in SICAS has been established to assist clinical practitioners in making clinical decisions and implementing personalized treatment measures.

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“…IAC in the intracranial internal carotid artery (ICA) has been shown to be an independent risk factor for ischemic stroke, accounting for 75% of all strokes [ 48 ]. A study found that the hyperintensity of T1WI in the culprit plaque of sICAS was independently associated with recurrence in stroke patients after six months [ 49 ]. Previous studies on carotid plaques showed that the hyperintensity of the T1WI often represented IPH or lipid nucleation, which increased the risk of plaque rupture and the occurrence of arterial embolism resulting in stroke recurrence.…”

Section: Hrmri Of Intracranial Atherosclerotic Diseasementioning

confidence: 99%

The Role of High-Resolution Magnetic Resonance Imaging in Cerebrovascular Disease: A Narrative Review

Liu

Zhu

et al. 2023

Brain Sciences

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High-resolution magnetic resonance imaging (HRMRI) is the most important and popular vessel wall imaging technique for the direct assessment of vessel wall and cerebral arterial disease. It can identify the cause of stroke in high-risk plaques and differentiate the diagnosis of head and carotid artery dissection, including inflammation, Moya Moya disease, cerebral aneurysm, vasospasm after subarachnoid hemorrhage, reversible cerebral vasoconstriction syndrome, blunt cerebrovascular injury, cerebral arteriovenous malformations, and other stenosis or occlusion conditions. Through noninvasive visualization of the vessel wall in vitro, quantified assessment of luminal stenosis and pathological features of the vessel wall can provide clinicians with further disease information. In this report, technical considerations of HRMRI are discussed, and current clinical applications of HRMRI are reviewed.

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Predictive value of the combination between the intracranial arterial culprit plaque characteristics and the Essen Stroke Risk Score for short-term stroke recurrence

Cited by 11 publications

References 24 publications

Association between high-resolution magnetic resonance vessel wall imaging characteristics and recurrent stroke in patients with intracranial atherosclerotic steno-occlusive disease: A prospective multicenter study

Association between high-resolution magnetic resonance vessel wall imaging characteristics and recurrent stroke in patients with intracranial atherosclerotic steno-occlusive disease: A prospective multicenter study

An interpretable machine learning model for stroke recurrence in patients with symptomatic intracranial atherosclerotic arterial stenosis

The Role of High-Resolution Magnetic Resonance Imaging in Cerebrovascular Disease: A Narrative Review

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