Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China.
Department of Neurology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China.
Eur Radiol. 2024 May;34(5):3022-3031. doi: 10.1007/s00330-023-10278-y. Epub 2023 Oct 23.
To evaluate the predictive ability of plaque characteristics for long-term stroke recurrence among patients with symptomatic intracranial atherosclerotic disease (ICAD).
This cohort study included 132 patients with acute ischemic stroke (AIS) attributed to ICAD who were recruited between July 2017 and December 2020 and followed until stroke recurrence or December 2021. Plaque surface irregularity, degree of stenosis, plaque burden, remodeling ratio, enhancement ratio, and intraplaque hemorrhage were assessed with 3-dimensional high-resolution magnetic resonance vessel wall imaging (3D HR-MRI). Data were analyzed using Cox models, receiver operating characteristic (ROC) curves, and Kaplan-Meier survival analysis.
Of the 132 patients, during a median follow-up of 2.8 years, stroke recurrence occurred in 35 patients. The multivariable-adjusted hazard ratio (95% confidence interval) of stroke recurrence was 3.15 (1.34-7.42) per 10% increase in plaque burden and 2.17 (1.27-3.70) for enhancement ratio. The area under the curve (AUC) to predict stroke recurrence was 0.725 (95% CI 0.629-0.822) for plaque burden, 0.692 (95% CI 0.593-0.792) for enhancement ratio, and only 0.595 (95% CI 0.492-0.699) for the Essen stroke risk score. The Kaplan-Meier survival analysis further demonstrated significant differences in survival of free recurrent stroke between patients with plaque burden or enhancement ratio below and above the optimum cut-offs (both p < 0.001).
Higher plaque burden and enhancement ratio are independent risk factors for long-term stroke recurrence among patients with symptomatic ICAD, and valuable imaging markers for predicting and stratifying risk of stroke recurrence.
In patients with symptomatic ICAD, the results of this high-resolution magnetic resonance vessel wall imaging study have potential implications for optimal management of intracranial plaques and secondary prevention of stroke recurrence based on plaque burden and enhancement ratio.
• Identification of intracranial plaque characteristics responsible for stroke recurrence is essential to preventing stroke recurrence in patients with symptomatic intracranial atherosclerotic disease. • Higher plaque burden and enhancement ratio are independent risk factors for stroke recurrence. • Plaque burden and enhancement ratio are valuable imaging markers in the prediction and stratification of the risk of stroke recurrence.
评估斑块特征对症状性颅内动脉粥样硬化性疾病（ICAD）患者长期卒中复发的预测能力。
本队列研究纳入了 2017 年 7 月至 2020 年 12 月期间因 ICAD 导致急性缺血性卒中（AIS）的 132 例患者，并对其进行了随访，直至卒中复发或 2021 年 12 月。采用三维高分辨率磁共振血管壁成像（3D HR-MRI）评估斑块表面不规则性、狭窄程度、斑块负荷、重塑比、强化比和斑块内出血。使用 Cox 模型、受试者工作特征（ROC）曲线和 Kaplan-Meier 生存分析进行数据分析。
在中位随访 2.8 年期间，132 例患者中有 35 例发生卒中复发。多变量调整后的危险比（95%置信区间）为斑块负荷每增加 10%，卒中复发的风险增加 3.15（1.34-7.42）；强化比每增加 10%，卒中复发的风险增加 2.17（1.27-3.70）。预测卒中复发的曲线下面积（AUC）为斑块负荷 0.725（95%CI 0.629-0.822），强化比 0.692（95%CI 0.593-0.792），Essen 卒中风险评分仅为 0.595（95%CI 0.492-0.699）。Kaplan-Meier 生存分析进一步表明，斑块负荷或强化比低于和高于最佳截断值的患者之间的无复发性卒中生存存在显著差异（均 p<0.001）。
症状性 ICAD 患者中，较高的斑块负荷和强化比是长期卒中复发的独立危险因素，是预测和分层卒中复发风险的有价值的影像学标志物。
在症状性 ICAD 患者中，这项高分辨率磁共振血管壁成像研究的结果表明，基于斑块负荷和强化比，可以优化颅内斑块的管理并预防卒中复发。
确定导致卒中复发的颅内斑块特征对于预防症状性颅内动脉粥样硬化性疾病患者的卒中复发至关重要。
较高的斑块负荷和强化比是卒中复发的独立危险因素。
斑块负荷和强化比是预测和分层卒中复发风险的有价值的影像学标志物。
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