Ren Kaixuan, He Juan, Zhu Li, Gu Yue, Qu Hang, Zhao Yi, Wang Wei
Department of Medical Imaging, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China.
Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China.
Front Neurol. 2024 Nov 19;15:1478583. doi: 10.3389/fneur.2024.1478583. eCollection 2024.
Recurrent ischemic stroke in patients with symptomatic intracranial atherosclerotic stenosis (sICAS) can be attributed to two main causes: intracranial atherosclerotic stenosis (ICAS) and cerebral small vessel disease (CSVD). This study investigates the potential associations between stroke recurrence and the modified cerebral small vessel disease (mCSVD) burden score, as well as the characteristics of culprit plaques related to intracranial artery high-resolution vessel wall imaging (HR-VWI).
A total of 145 patients presenting sICAS underwent intracranial artery HR-VWI and routine cranial MRI at two large Chinese hospitals from December 2019-2022 were participants of this retrospective analysis. Standard MRI scans were used to calculate the mCSVD score. Following a 12-month observation period, the patients were categorized into two distinct groups depending on whether or not they experienced a subsequent stroke.
Within 12 months, 32 patients experienced stroke recurrence. The recurrence group's mCSVD score was higher compared to the non-recurrence group ( < 0.001). Their luminal stenosis and culprit plaque thickness and burden were also higher ( < 0.05). Additionally, higher rates of diabetes, T1WI hyperintensity of culprit plaques, and significant plaque enhancement were observed in the recurrence group ( < 0.05). The adjusted Cox regression model indicated that the mCSVD score (HR = 1.730, 95% CI 1.021-2.933, = 0.042) and T1WI hyperintensity of the culprit plaque (HR = 6.568, 95% CI 1.104-39.059, = 0.039) remained significantly independent risk variables. The combination of the mCSVD score and T1WI hyperintensity of the culprit plaque demonstrated the highest efficacy in predicting stroke recurrence ( = 2.678, < 0.05).
The mCSVD score, associated with T1WI hyperintensity of culprit plaque, effectively predicts stroke recurrence and can be easily obtained, offering high clinical value.
有症状的颅内动脉粥样硬化性狭窄（sICAS）患者复发性缺血性卒中可归因于两个主要原因：颅内动脉粥样硬化性狭窄（ICAS）和脑小血管病（CSVD）。本研究调查卒中复发与改良脑小血管病（mCSVD）负担评分之间的潜在关联，以及与颅内动脉高分辨率血管壁成像（HR-VWI）相关的罪犯斑块特征。
2019年12月至2022年期间，两所大型中国医院共145例出现sICAS的患者接受了颅内动脉HR-VWI和常规头颅MRI检查，参与了这项回顾性分析。使用标准MRI扫描计算mCSVD评分。经过12个月的观察期后，根据患者是否发生后续卒中将其分为两个不同的组。
在12个月内，32例患者发生卒中复发。复发组的mCSVD评分高于未复发组（<0.001）。他们的管腔狭窄以及罪犯斑块厚度和负担也更高（<0.05）。此外，复发组中糖尿病、罪犯斑块T1WI高信号和显著斑块强化的发生率更高（<0.05）。调整后的Cox回归模型表明，mCSVD评分（HR = 1.730，95%CI 1.021 - 2.933，= 0.042）和罪犯斑块T1WI高信号（HR = 6.568，95%CI 1.104 - 39.059，= 0.039）仍然是显著的独立风险变量。mCSVD评分与罪犯斑块T1WI高信号的组合在预测卒中复发方面显示出最高的效能（= 2.678，<0.05）。
与罪犯斑块T1WI高信号相关的mCSVD评分可有效预测卒中复发，且易于获得，具有较高的临床价值。
