Progression of Plaque Burden of Intracranial Atherosclerotic Plaque Predicts Recurrent Stroke/Transient Ischemic
Zhang Shi1, Jing Li1, Ming Zhao2,3
1Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China.
Insights
Higher-resolution magnetic resonance imaging (HR-MRI) can predict recurrent stroke in patients with intracranial atherosclerotic disease (ICAD). Plaque burden progression identified by HR-MRI is a key indicator for stroke recurrence risk.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Imaging
Background:
- Intracranial atherosclerotic disease (ICAD) is a significant cause of recurrent stroke.
- Higher-resolution magnetic resonance imaging (HR-MRI) has potential prognostic value in ICAD, but its utility is under-investigated.
Purpose of the Study:
- To evaluate the predictive capability of intracranial atherosclerotic plaque features, assessed by HR-MRI, for recurrent cerebrovascular ischemic events.
Main Methods:
- A prospective study included 58 patients with recent stroke or TIA.
- HR-MRI (3.0T) was used to assess plaque burden (PB), stenosis, and lumen area at baseline and follow-up (>3 months).
- Clinical follow-up for recurrent ischemic events was conducted for up to 48 months; Cox regression analyzed associations.
Main Results:
- 20.7% of patients experienced recurrent ipsilateral events within approximately 11 months.
- Progression of plaque burden (PB) was significantly associated with recurrent events in univariable and multivariable analyses.
- Multivariable analysis identified PB progression as an independent predictor (HR, 6.293; P < 0.05).
Conclusions:
- Progression of plaque burden, detected by HR-MRI, is an independent imaging biomarker for recurrent ischemic cerebrovascular events.
- HR-MRI can aid in the risk stratification of patients with ICAD prone to recurrent stroke.
Background:
Patients with intracranial atherosclerotic disease (ICAD) have a high frequency of stroke recurrence. However, there has been little investigation into the prognostic value of higher-resolution magnetic resonance imaging (HR-MRI).
Purpose:
To investigate the use of intracranial atherosclerotic plaques features in predicting risk of recurrent cerebrovascular ischemic events using HR-MRI.
Study Type:
Prospective.
Population:
Fifty-eight patients with acute/subacute stroke (N = 46) or transient ischemic attack (N = 12).
Field Strength/Sequence:
A 3.0 T, 3D time-of-flight gradient echo sequence and T1- and T2-weighted fast spin echo sequences with 0.31 x 0.39 mm2 in-plane resolution, twice (with >3 months between scans) following the initial event.
Assessment:
Patients were also followed clinically for recurrent ischemic events for up to 48 months or until a subsequent event occurred. The degree of stenosis, plaque burden (PB), minimal lumen area (MLA), and contrast enhancement ratio were assessed at each scanning session and the percentage change of each over time was calculated.
Statistical Tests:
Univariable and multivariable Cox regression analyses were used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for predicting recurrent events.
Results:
The mean time interval between baseline and follow-up MRI scans was 6.2 ± 4.1 months. After the second MRI scan, 20.7% of patients (N = 12) had experienced ipsilateral recurrent TIA/stroke within 10.9 ± 9.2 months. Univariable analyses showed that baseline triglyceride, percentage change of PB, and progression of PB were significantly associated with recurrent events (all P < 0.05). Multivariable Cox regression indicated that progression of PB (HR, 6.293; 95% CI, 1.620-24.444; P < 0.05) was a significant independent imaging feature for recurrent ischemic events.
Data Conclusion:
Progression of PB was independently associated with recurrent ischemic cerebrovascular events. HR-MRI may help risk stratification of patients at risk of recurrent stroke.
Level Of Evidence:
2 TECHNICAL EFFICACY: Stage 4.
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