Correlation between characteristics of intracranial atherosclerotic plaques and ischemic stroke in high-resolution vascular wall MRI

Abstract

Background Intracranial atherosclerotic stenosis is a major cause of ischemic stroke, accounting for 30% of ischemic strokes in Asian populations. Purpose To investigate the relationship between the degree of arterial stenosis and enhancement grade of intracranial atherosclerotic disease (ICAD), the plaque characteristics in different remodeling patterns, and its potential impact. Material and Methods A total of 210 patients diagnosed with ICAD were enrolled in this retrospective study. Patients were divided into the middle cerebral artery (MCA) group (101 cases), posterior cerebral artery (PCA) group (14 cases), basilar artery (BA) group (71 cases), and intracranial segment of vertebral artery (VA) group (90 cases) according to the difference of diseased vessels. Data on presence or absence of ischemic infarction, intracranial vascular position of lesions, plaque characteristics, ICAD enhancement grade, remodeling index, and degree of arterial stenosis were collected for analysis. Results The incidence of ischemic infarction in enhancement grade 2 was significantly higher than that in enhancement grade 1 in MCA group ( P = 0.019). Enhancement grade 2 of ICAD was an independent risk factor for the development of ischemic infarction (odds ratio = 4.60; 95% confidence interval: 1.91–11.03; P = 0.001). There was no significant statistical difference in infarct rate between different remodeling modalities ( P>0.05). Conclusion Enhancement grade of ICAD is significantly associated with the degree of stenosis and the occurrence of ischemic stroke, which varies in different intracranial vessels. The pattern of vascular remodeling varies among different intracranial vessels, and the pattern of vascular remodeling has a significant impact on plaque characteristics.

A Non-Linear Role of Hyperlipidemia on Progression of Intracranial Atherosclerotic Plaques and Acute Downstream Ischemic Events

“…Consistent with previous studies [23][24][25][26] , our findings supported that plaque enhancement grading was the most prominent feature of ICAS plaque contributing to acute ischemic events; and there was a doseresponse relationship with higher risk of acute ischemic events with increasing levels of enhancement grades. So far, there has been a scarcity of definite pathological studies on the mechanism of intracranial sample size and selection bias should be cautiously considered.…”

Qualitative and quantitative plaque enhancement on high‐resolution vessel wall imaging predicts symptomatic intracranial atherosclerotic stenosis

“…With the development of neuroimaging techniques, high‐resolution vessel wall imaging (HR‐VWI) can be used to assess the plaque characteristics of ICAS. Plaque enhancement on HR‐VWI was significantly associated with IS in previous studies, and the recurrence rate of stroke increased with the increasing degree of plaque enhancement (Lee et al., 2018; Song et al., 2021; Sun et al., 2022; Wang et al., 2019). In addition, plaque characteristics, such as plaque burden and plaque area, showed a significant correlation with recurrent acute IS (Ran et al., 2020; Sun et al., 2021).…”

Chitinase-3 like-protein-1, matrix metalloproteinase -9 and positive intracranial arterial remodelling

“…Patients with BAR scores ≥1 times the standard deviation were defined as individuals with positive intracranial arterial remodelling; those with BAR scores <1 times the standard deviation were defined as individuals with non-positive intracranial arterial remodelling (Man and Xu, 2017; Figure 2). The patients were divided into two groups: positive and non-positive remodelling groups for all arteries, positive and non-positive remodelling groups for the anterior circulation, and positive and non-positive remodelling groups for the posterior circulation (Sun J. et al, 2022).…”

“…Matrix metalloproteinase (MMP)-9 can lead to vascular remodelling by mediating vascular matrix fibrosis and promoting atherosclerosis (Pahk et al, 2019). Most previous studies on intracranial arterial remodelling are retrospective studies of stroke patients who were part of an endpoint event that had occurred and had diagnostic value but lacked ideas for preventive treatment (Sun J. et al, 2022;Kaur et al, 2023). The burden caused by prolonged dilatory remodelling of the vessel wall is transmitted from large vessels to small vessels.…”