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The Tortuosity of Middle Cerebral Artery is Associated with Ipsilateral Recurrence of Ischemic Events

Yuan Chen1, Yifan Wang2, Yanan Zhu3

  • 1Department of Neurology, Siyang Hospital.

Journal of Atherosclerosis and Thrombosis
|April 23, 2026
PubMed
Abstract

Insights

Lower middle cerebral artery tortuosity in patients with intracranial atherosclerotic disease is linked to increased risk of recurrent ischemic stroke. This finding highlights tortuosity as a potential predictor for stroke recurrence.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Medical Imaging

Background:

  • Intracranial atherosclerotic disease (ICAD) is a significant cause of ischemic stroke.
  • The M1 segment of the middle cerebral artery (MCA) is a common site for ICAD.
  • The relationship between MCA tortuosity and stroke recurrence in ICAD patients needs further investigation.

Purpose of the Study:

  • To determine if the tortuosity of the culprit MCA is associated with recurrent ipsilateral ischemic events in patients with M1-ICAD.
  • To evaluate the predictive value of MCA tortuosity for stroke recurrence.

Main Methods:

  • 279 patients with first-ever M1-ICAD stroke were analyzed.
  • MCA M1 segment morphology was assessed using angiography to calculate the tortuosity index.
  • Patients were stratified by tortuosity index tertiles, and recurrence rates were compared using Cox regression and log-rank tests.

Main Results:

  • A statistically significant difference in recurrence rates was observed across tortuosity index groups (p = 0.003).
  • Higher tortuosity was inversely associated with recurrence (HR = 0.96, p = 0.037).
  • The lowest tortuosity group (Q1) had a significantly higher risk of recurrence compared to the highest tortuosity group (Q3) (HR = 5.39, p = 0.005).

Conclusions:

  • Lower tortuosity of the culprit MCA is a significant predictor of recurrent ipsilateral ischemic events in patients with M1-ICAD.
  • MCA tortuosity assessment may aid in risk stratification for stroke recurrence in this patient population.
Keywords:
Cerebral ischemic eventIntracranial atherosclerotic diseaseMiddle cerebral arteryRecurrenceTortuosity index

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