Intracranial Plaque Characteristics and Extracranial Carotid Plaque-RADS Associated With Stroke Recurrence: A
Wenqiao Zheng1,2, Yichun Qu1,2, Fanyu Du1,2
1Department of Radiology, The First Hospital of Shanxi Medical University, Taiyuan, China.
Insights
Intracranial plaque enhancement ratio, intraplaque hemorrhage (IPH), and extracranial carotid Plaque-RADS predict stroke recurrence. Combining these factors improves stroke recurrence risk assessment.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Research
Background:
- Extracranial carotid plaques are linked to stroke recurrence, but combined intracranial and extracranial plaque characteristics' association remains unclear.
- High-resolution vessel wall imaging (HR-VWI) offers detailed plaque assessment.
Purpose of the Study:
- To evaluate the association between intracranial plaque features and extracranial carotid Plaque Reporting and Data System (Plaque-RADS) with stroke recurrence.
- Utilize HR-VWI for comprehensive plaque analysis in ischemic stroke patients.
Main Methods:
- Retrospective study of 388 intracranial atherosclerotic ischemic stroke patients.
- HR-VWI performed within 7 days of stroke onset, assessing stenosis, burden, enhancement ratio, remodeling index, and intraplaque hemorrhage (IPH).
- Statistical analyses included Cox regression and time-dependent ROC curves over a median 24-month follow-up.
Main Results:
- 55 patients (14.2%) experienced recurrent stroke during follow-up.
- Intracranial plaque enhancement ratio (HR=1.62), IPH (HR=2.55), and extracranial carotid Plaque-RADS (HR=2.23) were significantly associated with stroke recurrence.
- A combined Cox model incorporating these factors achieved a maximum AUC of 0.79 for predicting recurrence.
Conclusions:
- Intracranial plaque enhancement ratio, IPH, and extracranial carotid Plaque-RADS are significant predictors of ischemic stroke recurrence.
- Combining these imaging biomarkers enhances the assessment of stroke recurrence risk.
- HR-VWI provides valuable insights into plaque vulnerability and stroke risk stratification.
Background:
In addition to intracranial plaques, extracranial carotid plaques have also been linked to stroke recurrence. However, the association of combined intracranial and extracranial plaque characteristics with stroke recurrence remains unclear.
Purpose:
To evaluate the association between intracranial plaque features and extracranial carotid Plaque Reporting and Data System (Plaque-RADS) with stroke recurrence utilizing high-resolution vessel wall imaging (HR-VWI).
Study Type:
Retrospective.
Population:
The 388 intracranial atherosclerotic ischemic stroke patients (mean age, 57.3 ± 11.5 years, 274 males).
Field Strength/Sequence:
3T, three-dimensional T1 weighted 3D fast spin echo.
Assessment:
HR-VWI was performed in all patients within 7 days of the stroke onset. The imaging features assessed included intracranial plaque characteristics (degree of stenosis, plaque burden, enhancement ratio, remodeling index, and intraplaque hemorrhage [IPH]) and extracranial carotid Plaque-RADS. Patients enrolled between May 2022 and July 2024 were included in the study. All patients were followed for a minimum of 12 months.
Statistical Tests:
Mann-Whitney U test or χ 2 test, univariate and multivariate Cox regression analyses, time-dependent ROC and AUC curves, and Kaplan-Meier survival curves. p-values less than 0.05 were regarded as statistically significant.
Results:
During a median follow-up period of 24 months, 55 patients experienced recurrent stroke. Intracranial plaque enhancement ratio (HR, 1.62; 95% CI, 1.11-2.38), IPH (HR, 2.55; 95% CI, 1.47-4.40), and extracranial carotid Plaque-RADS (HR, 2.23; 95% CI, 1.29-3.86) were significantly associated with stroke recurrence. Time-dependent ROC indicated that the maximum AUCs for enhancement ratio, IPH, and Plaque-RADS were 0.75, 0.69, and 0.68, respectively, while the Cox model including all three reached a maximum AUC of 0.79.
Data Conclusion:
The combination of intracranial plaque characteristics and extracranial carotid Plaque-RADS can be used to assess ischemic stroke recurrence.
Evidence Level:
3.
Technical Efficacy:
Stage 2.
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