Large Culprit Plaque and More Intracranial Plaques Are Associated with Recurrent Stroke: A Case-Control Study Using
1From The School of Medicine (G.W., H.W.), Nankai University, Tianjin, China.
Insights
Large culprit plaque volume and a higher number of intracranial plaques are independent predictors of recurrent stroke. Whole-brain imaging can identify patients at increased risk for stroke recurrence.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Research
Background:
- Intracranial atherosclerotic plaque characteristics are linked to recurrent stroke.
- Previous research often focused on single lesions, neglecting perfusion deficits.
- A comprehensive analysis of whole-brain plaque features and perfusion is needed.
Purpose of the Study:
- To investigate the association between whole-brain plaque features, perfusion deficits, and stroke recurrence.
- To identify specific plaque characteristics indicative of recurrent stroke risk.
Main Methods:
- Retrospective collection of ischemic stroke patients due to intracranial atherosclerosis.
- High-resolution vessel wall imaging and dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI).
- Logistic regression analysis to determine independent predictors of recurrent stroke.
Main Results:
- Recurrent stroke patients had larger culprit plaque volume and more intracranial plaques compared to first-time stroke patients.
- Culprit plaque volume (OR, 1.16) and total plaque number (OR, 1.31) were independently associated with recurrent stroke.
- Combining these factors improved the predictive model's area under the curve to 0.71.
Conclusions:
- Significant culprit plaque volume and a higher number of intracranial plaques are independently associated with recurrent stroke.
- Whole-brain vessel wall imaging aids in identifying patients at higher risk for recurrent stroke.
- This approach enhances risk stratification for stroke recurrence in intracranial atherosclerosis.
Background And Purpose:
Intracranial atherosclerotic plaque features are potential factors associated with recurrent stroke, but previous studies only focused on a single lesion, and few studies investigated them with perfusion impairment. This study aimed to investigate the association among whole-brain plaque features, perfusion deficit, and stroke recurrence.
Materials And Methods:
Patients with ischemic stroke due to intracranial atherosclerosis were retrospectively collected and categorized into first-time and recurrent-stroke groups. Patients underwent high-resolution vessel wall imaging and DSC-PWI. Intracranial plaque number, culprit plaque features (such as plaque volume/burden, degree of stenosis, enhancement ratio), and perfusion deficit variables were recorded. Logistic regression analyses were performed to determine the independent factors associated with recurrent stroke.
Results:
One hundred seventy-five patients (mean age, 59 [SD, 12] years; 115 men) were included. Compared with the first-time stroke group (n = 100), the recurrent-stroke group (n = 75) had a larger culprit volume (P = .006) and showed more intracranial plaques (P < .001) and more enhanced plaques (P = .003). After we adjusted for other factors, culprit plaque volume (OR, 1.16 per 10-mm3 increase; 95% CI, 1.03-1.30; P = .015) and total plaque number (OR, 1.31; 95% CI, 1.13-1.52; P < .001) were independently associated with recurrent stroke. Combining these factors increased the area under the curve to 0.71.
Conclusions:
Large culprit plaque and more intracranial plaques were independently associated with recurrent stroke. Performing whole-brain vessel wall imaging may help identify patients with a higher risk of recurrent stroke.
