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Author Spotlight: Assessing Ischemic Stroke Damage Through Middle Cerebral Artery Occlusion Model
Published on: August 11, 2023
Association of Plaque Morphology With Stroke Mechanism in Patients With Symptomatic Posterior Circulation ICAD
Xiaoyan Song1, Shuang Li1, Heng Du1
1From the Departments of Neurology (X.S., Q.H., Y.G., Y.H., H.L., G.W., Q.W.)Radiology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine; Departments of Medicine and Therapeutics (S.L.), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; Department of Health Technology and Informatics (H.D., X.C.), The Hong Kong Polytechnic University, Hung Hom, Kowloon; Department of Psychology (L.Z.), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China.
Insights
Shorter, less burdensome, and smoother plaques in intracranial atherosclerosis are linked to perforating artery occlusion (PAO) strokes. Conversely, longer, more irregular plaques are associated with artery-to-artery embolism (AAE) strokes.
Area of Science:
- Neurology
- Cardiovascular Research
- Medical Imaging
Background:
- Intracranial atherosclerotic disease (ICAD) is a significant cause of stroke.
- Key stroke mechanisms in ICAD include perforating artery occlusion (PAO) and artery-to-artery embolism (AAE).
- The specific morphological characteristics of plaques leading to PAO versus AAE remain incompletely understood.
Purpose of the Study:
- To investigate and compare the morphological features of symptomatic intracranial atherosclerotic plaques.
- To determine how plaque morphology differs between PAO and AAE stroke mechanisms in patients with ICAD.
Main Methods:
- Prospective recruitment of 51 patients with acute ischemic stroke in the posterior circulation due to ICAD.
- High-resolution MRI was used to assess plaque morphology (length, burden, surface irregularity, etc.).
- Patients were categorized into PAO or AAE groups, and morphological parameters were compared using nonparametric tests and logistic regression.
Main Results:
- Plaques in the PAO group were significantly shorter and had lower plaque burden compared to the AAE group.
- Plaque surface irregularity was more prevalent in the AAE group (92.30%) than in the PAO group (50.00%).
- Shorter plaque length was independently associated with the PAO mechanism.
Conclusions:
- Significant differences exist in intracranial atherosclerotic plaque morphology between PAO and AAE stroke mechanisms.
- Plaques characterized by shorter length, lower burden, and regular surfaces are more likely to cause PAO.
- These findings enhance understanding of stroke mechanisms in ICAD and may inform risk stratification.
Background And Objectives:
Although the main mechanisms of stroke in patients with intracranial atherosclerotic disease (ICAD)-perforating artery occlusion (PAO) and artery-to-artery embolism (AAE)-have been identified and described, relatively little is known about the morphology of the symptomatic plaques and how they differ between these 2 mechanisms.
Methods:
We prospectively recruited patients with acute ischemic stroke in the posterior circulation that was attributable to ICAD. Fifty-one eligible patients were enrolled and underwent magnetic resonance imaging before being assigned to the PAO or AAE group according to probable stroke mechanism. Plaque morphological properties including plaque length, lumen area, outer wall area, plaque burden, plaque surface irregularity, vessel wall remodeling, and plaque enhancement were assessed using high-resolution MRI. Plaque morphological parameters of both PAO and AAE groups were compared using nonparametric tests. A binary logistic regression model was used to identify independent predictors while a receiver operating characteristic curve tested the sensitivity and specificity of the model.
Results:
Among patients who met the imaging eligibility criteria, 38 (74.5%) had PAO and 13 (25.5%) had AAE. Plaque length was shorter (6.39 interquartile range [IQR, 5.18-7.7]1 mm vs 10.90 [IQR, 8.18-11.85] mm, p < 0.01) in patients with PAO. Plaque burden was lower in PAO group (78.00 [IQR, 71.94-86.35] % vs 86.37 [IQR, 82.24-93.04] %, p = 0.04). The proportion of patients with plaque surface irregularity was higher in patients with AAE than in patients with PAO (19/38, 50.00% vs 12/13, 92.30%, p = 0.008). Plaque length was significantly associated with the PAO mechanism (adjusted OR 0.57, 95% CI, 0.41-0.79).
Discussion:
Intracranial atherosclerotic plaque morphology differs between patients with PAO and those with AAE. Plaque with shorter length, lower plaque burden, and regular surface is more likely to cause PAO.
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