Differential Features of Culprit Intracranial Atherosclerotic Lesions: A Whole‐Brain Vessel Wall Imaging Study in Patients With Acute Ischemic Stroke

Abstract

BackgroundIntracranial atherosclerotic disease tends to affect multiple arterial segments. Using whole‐brain vessel wall imaging, we sought to study the differences in plaque features among various types of plaques in patients with a recent unilateral anterior circulation ischemic stroke.Methods and ResultsSixty‐one patients with unilateral anterior circulation ischemic stroke were referred to undergo whole‐brain vessel wall imaging (before and after contrast) within 1 month of symptom onset for intracranial atherosclerotic disease evaluations. Each plaque was classified as a culprit, probably culprit, or nonculprit lesion, according to its likelihood of causing the stroke. The associations between plaque features (thickening pattern, plaque‐wall contrast ratio, high signal on T1‐weighted images, plaque contrast enhancement ratio, enhancement grade, and enhancement pattern) and culprit lesions were estimated using mixed multivariable logistic regression after adjustment for maximum wall thickness. In 52 patients without motion corruption in whole‐brain vessel wall imaging, a total of 178 intracranial plaques in the anterior circulation were identified, including 52 culprit lesions (29.2%), 51 probably culprit lesions (28.7%), and 75 nonculprit lesions (42.1%). High signal on T1‐weighted images (adjusted odds ratio, 9.1; 95% confidence interval, 1.9–44.1; P=0.006), grade 2 (enhancement ratio of plaque ≥ enhancement ratio of pituitary) contrast enhancement (adjusted odds ratio, 17.4; 95% confidence interval, 1.8–164.9; P=0.013), and type 2 (≥50% cross‐sectional wall involvement) enhancement pattern (adjusted odds ratio, 10.1; 95% confidence interval, 1.3–82.2; P=0.030) were independently associated with culprit lesions.ConclusionsHigh signal on T1‐weighted images, grade 2 contrast enhancement, and type 2 enhancement pattern are associated with cerebrovascular ischemic events, which may provide valuable insights into risk stratification.

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“…In addition, pathological remodeling of cerebrovasculature has been proved to contribute to poor neuronal repair and worsened cognitive deficits in rats with diabetic stroke (Ward et al, ). In clinical researches, pathological vascular remodeling has been used as an approach and an indicator to evaluate the etiology (Sun & Yuan, ), risk stratification (Wu et al, ) and therapeutic efficacy (Abraham et al, ).…”

Risk Factors of Large Artery Atherosclerotic Ischemic Stroke Based on Carotid Contrast-Enhanced Ultrasonography

“…Varetto et al reported a statistically signi cant correlation between increased vascularization of carotid atherosclerotic plaques evaluated by CEUS and cerebrovascular neurological events [30]. Similarly, Wu et al concluded that strong contrast enhancement can reveal culprit lesions, likely suggesting greater neovascularization and/or in ammatory activity in atherosclerotic lesions [36].…”

“…Information on the degree of carotid stenosis was not included in this study. Recent atherosclerosis research has suggested that lumen narrowing may not be a reliable indicator of plaque severity because positive artery remodeling of the vessel wall is associated with the culprit lesions [36,37]. Notably, vulnerable atherosclerotic plaque may suggest an increased risk of cerebrovascular events, even with low-grade carotid narrowing [38].…”

Current uses of intracranial vessel wall imaging for clinical practice: a high-resolution MR technique recently available

“…Thus, the earlier phase of the positive remodeling of atheromatous plaques development on vessel walls was neglected 12 . Furthermore, the characterization of focal luminal narrowing by probable atheromatous plaques in asymptomatic patients did not allow the definition of adequate primary prevention, due to the impossibility of establishing a real risk 13 . .…”