Intracranial plaque with large lipid core is associated with embolic stroke of undetermined source

Abstract

Objective To investigate an association between percentage lipid‐rich necrotic core (LRNC) and an index ischemic stroke in an embolic stroke of undetermined source (ESUS) cohort. Methods A total of 167 ESUS patients with 259 non‐stenotic intracranial plaques including 155 ipsilateral and 104 contralateral to stroke were finally enrolled in the current analysis. The multi‐dimensional parameters involving remodeling index (RI), plaque burden (PB), LRNC, discontinuity of plaque surface (DPS), intraplaque hemorrhage (IPH), and vulnerable plaque defined as presence of complicated plaque were evaluated by high‐resolution magnetic resonance imaging. Results We found that %LRNC was an independent predictor for ESUS in model 1 (OR: 2.574, 95% CI: 1.854–3.573, P < 0.001), and model 2 (OR: 2.550, 95% CI: 1.835–3.545, P < 0.001), but the association was not seen in PB. In receiver operating characteristic curve analysis, the discrimination of LRNC for ESUS was significantly superior to that of PB (absolute difference: 0.121, 95% CI: 0.056–0.205, P < 0.001). Importantly, a significantly positive synergy between the remodeling pattern and LRNC in response to plaque vulnerability was found by Sankey diagram (P for interaction = 0.001). Conclusion This is the first report that LRNC, beyond PB, may be correlated with an index ESUS, and a synergistic effect between positive remodeling and larger LRNC could promote plaque vulnerability. The findings suggest that a potential target subgroup may benefit from stroke prevention with intensive statin, although this must be confirmed in future.

Characteristics of intracranial plaque in patients with non-cardioembolic stroke and intracranial large vessel occlusion

“…The PB was defined as (vessel area−luminal area/vessel area at MLN site)×100%, the percentage of PB was used to correct for varying with vessel size in which intracranial larger vessels usually had larger plaques. The %LRNC was defined as 100%×(LRNC area/vessel area−luminal area at MLN site), which was described in detail previously 4 18…”

High-resolution magnetic resonance vessel wall imaging in ischemic stroke and carotid artery atherosclerotic stenosis: A review

“…Moreover, HR-VWI is beneficial in selecting the appropriate treatment strategy [ 111 ]. For example, if unstable plaques or fragile vascular walls are noticed, active medical management or interventional procedures may be required to prevent future strokes [ 1 , 112 , 113 ]. In conclusion, HR-VWI has a key role in understanding stroke pathophysiology and etiology, identifying high-risk individuals, and guiding personalized treatment.…”

“…In conclusion, HR-VWI has a key role in understanding stroke pathophysiology and etiology, identifying high-risk individuals, and guiding personalized treatment. It improves our knowledge of the relationship between vascular wall abnormalities and stroke and ultimately results in better stroke prevention and management [ 94 , 104 , 105 , 112 ]. HR-VWI thus holds promising prospects for its application in ischemic stroke diagnosis and prevention.…”

“…They can gain valuable insights into atherosclerosis-associated structural changes and the accompanying plaque formation. With this non-invasive imaging technique, a detailed assessment of the vascular wall and the diagnosis and management of CAS are possible [ 39 , 40 , 73 , 98 , 112 ]. To thoroughly evaluate the characteristics of atherosclerotic plaques, a contrast agent is often injected to enhance the image scan quality.…”