Shao Shengyu, Wang Tianle, Zhu Li, Gao Yin, Fan Xian, Lu Yu, Qian Chengqun, Zhang Manyu, Qian Jinhua
Department of Medical Imaging, The Second Affiliated Hospital of Nantong University, Nantong, China.
Front Neurol. 2025 Jan 15;15:1514711. doi: 10.3389/fneur.2024.1514711. eCollection 2024.
To evaluate the ability of the plaque characteristics of extracranial carotid and intracranial arteries to predict large atherosclerotic ischemic stroke recurrence via head and neck combined high-resolution vessel wall imaging (HR-VWI).
This prospective cohort study included 169 patients with large atherosclerotic ischemic stroke who underwent head and neck combined HR-VWI from April 2022 to May 2023. The baseline clinical data and atherosclerotic plaque characteristics of the intracranial and extracranial carotid arteries were collected, and the patients were followed up for 1 year, with the endpoint event defined as recurrent ischemic stroke. Clinical and imaging data were compared between the recurrent and nonrecurrent groups. Independent risk factors associated with stroke recurrence were assessed via multivariate Cox regression analysis. The receiver operating characteristic (ROC) curves of the relevant variables were also plotted, and the area under the curve (AUC) was calculated to assess their ability to predict stroke recurrence. Kaplan-Meier survival curves were used to compare the probability of stroke recurrence.
During the 12-month follow-up, stroke recurrence occurred in 35 of the 169 patients. Multivariate Cox regression analysis revealed that the total number of intracranial and extracranial carotid plaques ( = 0.010) and coexisting extracranial carotid plaques and intracranial significantly enhanced plaques ( = 0.047) were independent risk factors for recurrent ischemic stroke. The AUCs for predicting stroke recurrence were 0.787 and 0.710, respectively. The Kaplan-Meier survival curve revealed that the risk of stroke recurrence was significantly greater in patients whose total number of intracranial and extracranial carotid plaques was >4.5 than in patients whose total number of plaques was <4.5 ( < 0.001) and was significantly greater in patients with coexisting extracranial carotid plaques and intracranial significantly enhanced plaques than in patients without coexisting plaques ( < 0.001).
A greater total number of intracranial and extracranial carotid plaques and the coexistence of extracranial carotid plaques and intracranially significantly enhanced plaques are independent risk factors associated with recurrent ischemic stroke. Head and neck combined HR-VWI may provide new indicators for the prediction of stroke recurrence, thus helping clinicians identify high-risk patients and target therapy to reduce the recurrence of ischemic events.
通过头颈部联合高分辨率血管壁成像（HR-VWI）评估颅外颈动脉和颅内动脉斑块特征预测大型动脉粥样硬化性缺血性卒中复发的能力。
这项前瞻性队列研究纳入了2022年4月至2023年5月期间接受头颈部联合HR-VWI检查的169例大型动脉粥样硬化性缺血性卒中患者。收集颅内和颅外颈动脉的基线临床数据和动脉粥样硬化斑块特征，并对患者进行1年随访，终点事件定义为复发性缺血性卒中。比较复发组和未复发组的临床和影像学数据。通过多因素Cox回归分析评估与卒中复发相关的独立危险因素。绘制相关变量的受试者工作特征（ROC）曲线，并计算曲线下面积（AUC）以评估其预测卒中复发的能力。采用Kaplan-Meier生存曲线比较卒中复发的概率。
在12个月的随访期间，169例患者中有35例发生卒中复发。多因素Cox回归分析显示，颅内和颅外颈动脉斑块总数（=0.010）以及并存的颅外颈动脉斑块和颅内显著强化斑块（=0.047）是复发性缺血性卒中的独立危险因素。预测卒中复发的AUC分别为0.787和0.710。Kaplan-Meier生存曲线显示，颅内和颅外颈动脉斑块总数>4.5的患者卒中复发风险显著高于斑块总数<4.5的患者（<0.001），并存颅外颈动脉斑块和颅内显著强化斑块的患者卒中复发风险显著高于无并存斑块的患者（<0.001）。
颅内和颅外颈动脉斑块总数较多以及颅外颈动脉斑块与颅内显著强化斑块并存是与复发性缺血性卒中相关的独立危险因素。头颈部联合HR-VWI可能为预测卒中复发提供新的指标，从而帮助临床医生识别高危患者并进行靶向治疗以降低缺血性事件的复发。
