The characteristics of atherosclerotic plaque associated with onset of acute ischemic stroke: a high-resolution magnetic resonance imaging study

Abstract

Background & Objective: The onset of cerebrovascular events is closely related to status of atherosclerotic plaque, especially vulnerable plaques, but the majority of vulnerable plaques remain clinically silent. This study aimed to investigate the characteristics of high-risk vulnerable plaque that correlate with the onset of acute ischemic stroke.

Methods: In this retrospective study. Patients were recruited if they conformed to acute unilateral internal carotid artery or middle cerebral artery territory infarction identified as artery to artery embolization with conjugated vulnerable plaque of bilateral internal carotid artery siphon or middle cerebral artery M1segment vulnerable plaques by 3.0-T high-resolution magnetic resonance imaging examination. Characteristics of vulnerable plaques were compared between culprit plaque and non-culprit plaque of the same patient.

Results: A total of 78 patients (64 males; mean age = 58.49 ± 10.38 years) were included. There were statistically significant difference in irregular surface, degree of stenosis, eccentricity index between culprit plaque and non-culprit plaque (P <0.05). Multivariate analysis showed that irregular surface (OR 5.897, 95%CI, 2.355-14.767, P <0.001), moderate stenosis (OR 3.163, 95%CI, 1.208 -8.283, P =0.019), and plaque enhancement (OR 2.551, 95%CI, 1.028 -6.328, P =0.043) were associated with culprit plaque. The area under the curve of plaque enhancement of irregular surface combined with moderate stenosis was 0.816 (95% CI 0.748-0.884, p =0.000). Plaque enhancement of irregular surface combined with moderate stenosis was associated with END (OR 2.131, 95% CI 1.224-3.712, p=0.008).

Conclusions: Plaque enhancement of irregular surface combined with moderate stenosis may be potential imaging markers for predicting the occurrence of thromboembolic strokes caused by intracranial large artery atherosclerosis and early neurologic deterioration.