Co-existing cerebrovascular atherosclerosis predicts subsequent vascular event: a multi-contrast cardiovascular
Jin Li1,2, Dongye Li2,3,4, Dandan Yang4
1Department of Radiology, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China.
Insights
Co-existing intracranial stenosis and vulnerable carotid plaques, especially those with lipid-rich necrotic cores, significantly predict future vascular events. This finding highlights the importance of assessing both intracranial and extracranial arteries for comprehensive stroke risk evaluation.
Area of Science:
- Neurology
- Cardiology
- Radiology
- Vascular Medicine
Background:
- The combined predictive value of intracranial stenosis and extracranial carotid vulnerable plaques for vascular events remains unclear.
- Assessing co-existing cerebrovascular atherosclerosis is crucial for understanding stroke risk.
Purpose of the Study:
- To investigate the relationship between co-existing extracranial carotid vulnerable plaques and intracranial stenosis.
- To determine their combined predictive value for subsequent vascular events using cardiovascular magnetic resonance (CMR) vessel wall imaging.
Main Methods:
- 150 patients with recent anterior circulation cerebrovascular symptoms were enrolled.
- Multi-contrast CMR vessel wall imaging and 3D time-of-flight CMR angiography were performed.
- Patients were followed for at least 1 year to identify recurrent vascular events.
Main Results:
- 41 (27.3%) patients experienced vascular events during a median follow-up of 12.1 months.
- Co-existing intracranial stenosis and extracranial carotid plaque (HR, 3.57) and lipid-rich necrotic core (LRNC) (HR, 4.47) were significantly associated with vascular events.
- These associations remained significant after adjusting for confounding factors and carotid stenosis (HRs 5.12 and 8.12, respectively).
Conclusions:
- Co-existing cerebrovascular atherosclerotic diseases are independent predictors of subsequent vascular events.
- The presence of carotid lipid-rich necrotic core combined with intracranial stenosis shows a particularly high predictive value.
- Comprehensive assessment of both intracranial and extracranial arteries is vital for stroke risk stratification.
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, 2.15-9.27; 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.
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