Association Between Intracranial Plaque Characteristics and Stroke Recurrence Risk Stratified by Stenosis Severity

This study aims to analyze the association between plaque characteristics and stroke recurrence across different degrees of stenosis, and to evaluate the predictive value of combining culprit plaque characteristics with the modified Essen score for stroke recurrence.

This retrospective analysis included 368 intracranial atherosclerotic stenosis (ICAS) patients from two centers, categorized into mild-to-moderate stenosis (<70%, n = 155) and severe stenosis (≥70%, n = 213) groups. High-resolution vessel wall images and clinical data were analyzed. Univariate and multivariate Logistic regression analyses were conducted to determine risk factors for stroke recurrence. The predictive performance was evaluated using the area under the receiver operating characteristic curve.

In the mild-to-moderate stenosis group, a higher Normalized Wall Index (NWI) (OR = 1.088, 95% CI: 1.009-1.186, P = .04) and the presence of intraplaque hemorrhage (IPH) (OR = 4.049, 95% CI: 1.227-16.065, P = .03) were risk factors for stroke recurrence, but not in severe stenosis. A combined model (IPH, NWI, modified Essen score) improved predictive performance over the modified Essen score alone, particularly in mild-to-moderate stenosis.

In patients with luminal stenosis of less than 70%, elevated NWI and IPH were validated as important and effective indicators for predicting stroke recurrence, demonstrating significant predictive performance. Conversely, plaque characteristics showed limited predictive utility in severe stenosis, highlighting stenosis-dependent differences in plaque-related stroke risk. Integrating imaging biomarkers with modified Essen score optimizes recurrence prediction in mild-to-moderate ICAS.