Yu Ying, Cui Rongrong, He Xin, Shi Xinxin, Hou Zhikai, Pan Yuesong, Li Mingyao, Yang Jiabao, Miao Zhongrong, Wang Yongjun, Wang Rong, Lou Xin, Yan Long, Ma Ning
Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
J Stroke. 2025 May;27(2):207-216. doi: 10.5853/jos.2024.03251. Epub 2025 May 31.
This study aimed to investigate the association between residual inflammatory risk (RIR) and vulnerable plaques using high-resolution magnetic resonance imaging (HRMRI) in symptomatic intracranial atherosclerotic stenosis (ICAS).
This retrospective study included 70%-99% symptomatic ICAS patients hospitalized from January 2016 to December 2022. Patients were classified into four groups based on high-sensitivity C-reactive protein (hs-CRP) and low-density lipoprotein cholesterol (LDL-C): residual cholesterol inflammatory risk (RCIR, hs-CRP ≥3 mg/L and LDL-C ≥2.6 mmol/L), RIR (hs-CRP ≥3 mg/L and LDL-C <2.6 mmol/L), residual cholesterol risk (RCR, hs-CRP <3 mg/L and LDL-C ≥2.6 mmol/L), and no residual risk (NRR, hs-CRP <3 mg/L and LDL-C <2.6 mmol/L). Vulnerable plaque features on HRMRI included positive remodeling, diffuse distribution, intraplaque hemorrhage, and strong enhancement.
Among 336 included patients, 21, 60, 58, and 197 were assigned to the RCIR, RIR, RCR, and NRR groups, respectively. Patients with RCIR (adjusted odds ratio [aOR], 3.606; 95% confidence interval [CI], 1.346-9.662; P=0.011) and RIR (aOR, 3.361; 95% CI, 1.774-6.368, P<0.001) had higher risks of strong enhancement than those with NRR. Additionally, patients with RCIR (aOR, 2.965; 95% CI, 1.060-8.297; P=0.038) were more likely to have intraplaque hemorrhage compared with those with NRR. In the sensitivity analysis, RCR (aOR, 2.595; 95% CI, 1.201-5.608; P=0.015) exhibited an additional correlation with an increased risk of intraplaque hemorrhage.
In patients with symptomatic ICAS, RIR is associated with a higher risk of intraplaque hemorrhage and strong enhancement, indicating an increased vulnerability to atherosclerotic plaques.
本研究旨在利用高分辨率磁共振成像（HRMRI）研究症状性颅内动脉粥样硬化性狭窄（ICAS）患者残余炎症风险（RIR）与易损斑块之间的关联。
这项回顾性研究纳入了2016年1月至2022年12月期间住院的70%-99%症状性ICAS患者。根据高敏C反应蛋白（hs-CRP）和低密度脂蛋白胆固醇（LDL-C）将患者分为四组：残余胆固醇炎症风险（RCIR，hs-CRP≥3mg/L且LDL-C≥2.6mmol/L）、RIR（hs-CRP≥3mg/L且LDL-C<2.6mmol/L）、残余胆固醇风险（RCR，hs-CRP<3mg/L且LDL-C≥2.6mmol/L）和无残余风险（NRR，hs-CRP<3mg/L且LDL-C<2.6mmol/L）。HRMRI上的易损斑块特征包括阳性重塑、弥漫分布、斑块内出血和强化明显。
在纳入的336例患者中，分别有21例、60例、58例和197例被分配到RCIR、RIR、RCR和NRR组。与NRR组相比，RCIR组（调整优势比[aOR]，3.606；95%置信区间[CI]，1.346-9.662；P=0.011）和RIR组（aOR，3.361；95%CI，1.774-6.368，P<0.001）强化明显的风险更高。此外，与NRR组相比，RCIR组（aOR，2.965；95%CI，1.060-8.297；P=0.038）更易发生斑块内出血。在敏感性分析中，RCR组（aOR，2.595；95%CI，1.201-5.608；P=0.015）与斑块内出血风险增加也存在额外关联。
在症状性ICAS患者中，RIR与斑块内出血和强化明显的风险较高相关，表明动脉粥样硬化斑块的易损性增加。
