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Performing Permanent Distal Middle Cerebral with Common Carotid Artery Occlusion in Aged Rats to Study Cortical Ischemia with Sustained Disability
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Differentiated risk factors for stroke recurrence in anterior versus posterior circulation intracranial

Caiya Yuan1, Lin Yang1

  • 1Radiology Department, Pangang Group General Hospital, Sichuan,617000, China.

Neuroimage. Reports
|April 21, 2026
PubMed

Insights

Risk factors for recurrent stroke in intracranial atherosclerosis differ between anterior and posterior circulations. Older age, multiple infarcts, and plaque enhancement predict anterior circulation strokes, while diabetes and intraplaque hemorrhage predict posterior circulation strokes.

Area of Science:

  • Neurology
  • Cardiovascular Research
  • Medical Imaging

Background:

  • Intracranial atherosclerosis (ICAS) poses a significant risk for recurrent ischemic stroke.
  • Risk factors for stroke recurrence may vary between the anterior circulation (ACIS) and posterior circulation (PCIS).
  • High-resolution vessel wall imaging (HR-VWI) provides detailed plaque characteristics crucial for understanding stroke mechanisms.

Purpose of the Study:

  • To investigate and compare the risk factors for recurrent stroke in patients with ICAS.
  • To differentiate risk factors based on whether the stroke occurred in the anterior or posterior circulation.
  • To leverage HR-VWI plaque features for improved risk stratification in ICAS.

Main Methods:

  • Retrospective analysis of 166 patients with ICAS-related ischemic stroke.
  • Categorization into anterior circulation ischemic stroke (ACIS) and posterior circulation ischemic stroke (PCIS) groups.
  • Comparison of clinical and imaging risk factors, including plaque characteristics, using multivariable Cox regression and ROC curve analysis.

Main Results:

  • For ACIS, older age, multiple infarcts, and significant plaque enhancement were independent predictors of recurrence.
  • For PCIS, diabetes mellitus and intraplaque hemorrhage (IPH) were independent predictors of recurrence.
  • Predictive models showed fair-to-good performance for ACIS (AUC: 0.821) and uncertain performance for PCIS (AUC: 0.770) due to sample size limitations.

Conclusions:

  • Recurrent stroke drivers in ICAS are distinct for anterior and posterior circulations.
  • Integrating clinical data with HR-VWI plaque features may enhance risk stratification for ICAS.
  • Circulation-specific secondary prevention strategies may be necessary for managing ICAS patients.
Abstract

Keywords:
Anterior circulationIntracranial atherosclerosisIschemic strokePosterior circulationRecurrenceVessel wall imaging

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