Plaque features and lenticulostriate artery morphology in unexplained early neurological deterioration in symptomatic
Yulu Shi1, Xiaoyan Bai2,3, Xue Zhang2,3
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Background:
A large proportion of early neurological deterioration (END) in stroke due to middle cerebral artery (MCA) stenosis remains unexplained. Unstable plaques on MCA and impaired perforators might contribute to unexplained END.
Methods:
We included patients with symptomatic MCA stenosis and classified them into three groups according to symptoms: END, stable, and transient ischemic attack (TIA). High-resolution 7 T vessel wall magnetic resonance imaging (MRI) (VW-MRI) and time-of-flight magnetic resonance (MR) angiography (TOF-MRA) were used to investigate MCA plaque features and lenticulostriate artery (LSA) morphology. We compared demographic data, plaque features and LSA morphology between three groups, and used binary logistic regression models to investigate factors that could potentially be related to END.
Results:
Fifty-two patients (49.46 ± 13.94 years, 39 males) were included in final analyses. Patients in three groups did not differ in age or vascular risk factors. Irregular plaque surface (16/16 vs 12/16 vs 11/20 in END vs stable vs TIA groups, P = 0.008) and plaques adjacent to LSA origin (14/16 vs 10/16 vs 7/20, P = 0.006) were more commonly seen in the END group than the other two groups. On TOF-MRA, TIA patients had more LSA branches (6[1,15] vs 5[1,9] vs 7[4,12] in END vs stable vs TIA groups, P = 0.018) and longer total LSA length (95.37 ± 43.98 vs 92.42 ± 33.10 vs 129.61 ± 38.77 mm, P = 0.012). Larger lesion size, higher LDL level and plaques adjacent to LSA origin were significantly associated with END, before and after the adjustment for age and sex.
Conclusion:
The 7 T MRA provide precise imaging capabilities for plaque characteristics and LSA in patients with MCA stenosis and END, which could help stratify the risks of END and provide evidence for treatment of ischemic stroke caused by MCA arthrosclerosis.
Insights
Unexplained early neurological deterioration in middle cerebral artery (MCA) stenosis is linked to unstable plaques and impaired perforators. High-resolution MRI reveals plaque features and lenticulostriate artery (LSA) morphology associated with this condition.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Research
Background:
- Early neurological deterioration (END) in middle cerebral artery (MCA) stenosis often lacks clear causes.
- Unstable MCA plaques and impaired perforating arteries are potential contributors to unexplained END.
Purpose of the Study:
- To investigate MCA plaque characteristics and lenticulostriate artery (LSA) morphology in patients with symptomatic MCA stenosis.
- To identify imaging features associated with early neurological deterioration (END) in MCA stenosis.
Main Methods:
- High-resolution 7 Tesla vessel wall MRI (VW-MRI) and time-of-flight MR angiography (TOF-MRA) were utilized.
- Patients with symptomatic MCA stenosis were categorized into END, stable, and transient ischemic attack (TIA) groups.
- Demographic data, plaque features, and LSA morphology were compared across groups, with logistic regression analyzing END predictors.
Main Results:
- Irregular plaque surfaces and plaques near LSA origin were more frequent in the END group.
- Patients with TIA showed more LSA branches and longer total LSA length compared to other groups.
- Larger lesion size, higher LDL, and plaques adjacent to LSA origin were significantly associated with END.
Conclusions:
- 7 Tesla MRI precisely images plaque characteristics and LSA in MCA stenosis patients.
- These findings aid in stratifying END risk and guiding treatment for ischemic stroke caused by MCA atherosclerosis.
