Association between perforator stroke after middle cerebral artery elective stenting and arterial remodeling patterns: a high-resolution MRI-based retrospective cohort study.

BACKGROUND

Patterns of arterial remodeling may be associated with outcomes in patients with severe middle cerebral artery (MCA) stenosis after endovascular treatment (EVT). This study aims to investigate the potential correlation between arterial remodeling patterns in patients with severe MCA stenosis, and plaque characteristics and procedure-related perforator stroke (PS).

METHODS

Consecutive patients with MCA atherosclerotic disease who underwent EVT at the First Affiliated Hospital of Zhengzhou University from January 2018 to June 2023 were retrospectively enrolled in this study. The clinical and surgical data of the patients were evaluated. Remodeling index values >1.05, 0.95-1.05, and <0.95 indicated positive remodeling (PR), intermediate remodeling (IR), and negative remodeling (NR), respectively. Based on the remodeling index values calculated by high-resolution magnetic resonance imaging (HR-MRI), the arterial remodeling patterns were classified as NR or non-NR; non-NR was defined as both PR and IR. The primary endpoint was procedure-related PS. Plaque characteristics included the plaque area, plaque burden, contrast-enhancement ratio, and plaque distribution. Plaque features and the incidence of procedure-related PS were compared between the NR and non-NR groups. Differences in the categorical variables between the patients with NR and non-NR were assessed using the Chi-square test (χ) or Fisher's exact test. Differences in the continuous variables between the two groups were assessed using the Student -test or Mann-Whitney -test.

RESULTS

A total of 65 patients (mean age: 57.6 years) were enrolled in the study. Of the patients, 45 (69.2%) showed NR and 20 (30.8%) showed non-NR. The primary endpoint of procedure-related PS occurred in 3 patients (3/65, 4.6%). On HR-MRI, the entire cohort had a mean plaque area of 10.0 mm, a mean plaque burden of 92.0 %, and a mean enhancement ratio of 1.3. Compared to the non-NR group, the NR group had a smaller plaque area (9.2 11.6 mm, P=0.001). The probability of the primary end point was 15.0% in the non-NR group and 0.0% in the NR group (P=0.026).

CONCLUSIONS

PS after MCA elective stenting may be related to non-NR based on HR-MRI. Further prospective and multicenter studies need to be conducted to confirm these findings.