Higher Plaque Burden of Middle Cerebral Artery Is Associated With Recurrent Ischemic Stroke: A Quantitative Magnetic
Yuncai Ran1, Yuting Wang2,3, Ming Zhu4
1From the Department of Magnetic Resonance (Y.R., X.L., F.Z., X. Wang, S.X., J. Zhou, J.C.), First Affiliated Hospital of Zhengzhou University, China.
Insights
Higher plaque burden in middle cerebral artery atherosclerotic plaques, identified by magnetic resonance vessel wall imaging, is independently linked to recurrent ischemic stroke. This finding aids in predicting stroke recurrence risk.
Area of Science:
- Neurology
- Cardiovascular Imaging
- Radiology
Background:
- Cerebral atherosclerosis is a significant cause of ischemic stroke.
- Understanding plaque characteristics is crucial for predicting stroke recurrence.
Purpose of the Study:
- To investigate the association between middle cerebral artery plaque characteristics and recurrent ischemic stroke.
- To utilize high-resolution black-blood magnetic resonance vessel wall imaging (MRI) for plaque assessment.
Main Methods:
- 105 patients with middle cerebral artery plaque-attributed ischemic stroke underwent MRI.
- Patients were categorized into first acute stroke, recurrent acute stroke, and chronic stroke groups.
- Plaque characteristics (area, burden, enhancement ratio, eccentricity, stenosis) were measured and analyzed.
Main Results:
- Recurrent stroke patients exhibited significantly greater plaque burden compared to other groups.
- Higher plaque burden was independently associated with recurrent ischemic stroke after adjusting for clinical factors (OR 2.26).
- Acute stroke groups showed higher enhancement ratios than the chronic stroke group.
Conclusions:
- Increased plaque burden in the middle cerebral artery, as visualized by MRI, is an independent predictor of recurrent ischemic stroke.
- MRI plaque characteristics offer valuable insights into stroke recurrence risk stratification.
Abstract:
Background and Purpose- This study aims to investigate the association between the characteristics of atherosclerotic plaques of middle cerebral artery and recurrent ischemic stroke using magnetic resonance vessel wall imaging. Methods- One hundred and five patients with ischemic stroke attributed to middle cerebral artery plaque underwent high-resolution black-blood magnetic resonance vessel wall imaging. They were divided into group 1, with the first episode of acute stroke (imaging within 4 weeks of stroke, n=44); group 2, with recurrent acute stroke (n=29); and group 3, with chronic stroke (imaging after 3 months of stroke, n=32). Plaque characteristics including plaque area, plaque burden, contrast-enhancement ratio, eccentricity, and degree of stenosis were measured and compared across 3 groups. Association between plaque characteristics and recurrent strokes was investigated by multivariate analysis. Results- Plaque burden was significantly greater in recurrent stroke group than the other 2 groups (median: group 2, 82.7%, versus group 1, 76.3%, and group 3, 73.4%; P=0.001). Patients with acute stroke had higher enhancement ratio than patients with chronic stroke (median: group 1, 1.59, and group 2, 1.90, versus group 3, 1.33; P=0.014). Comparing to first-onset acute stroke patients, recurrent stroke patients were older, more likely with female sex and hypertension, and had higher plaque burden. After adjustment of clinical factors, plaque burden was the only independent imaging feature associated with recurrent stroke (odds ratio, 2.26, per 10% increase [95% CI, 1.03-4.96]; P=0.042). Conclusions- Higher plaque burden of middle cerebral artery identified on magnetic resonance vessel wall imaging is independently associated with recurrent ischemic stroke.
