Association between high-resolution magnetic resonance vessel wall imaging characteristics and recurrent stroke in patients with intracranial atherosclerotic steno-occlusive disease: A prospective multicenter study

Weizhuang Yuan; Xiaoyun Liu; Zhongrui Yan; Bo Wu; Baoquan Lu; Beilei Chen; Daishi Tian; Ailian Du; Litao Li; Changyun Liu; Guangzhi Liu; Tao Gong; Zhimin Shi; Feng Feng; Caiyan Liu; Yao Meng; Qianqian Lin; Mingli Li; Wei-Hai Xu

doi:10.1177/17474930241228203

Association between high-resolution magnetic resonance vessel wall imaging characteristics and recurrent stroke in patients with intracranial atherosclerotic steno-occlusive disease: A prospective multicenter study

Int J Stroke. 2024 Feb 15:17474930241228203. doi: 10.1177/17474930241228203. Online ahead of print.

Authors

Weizhuang Yuan¹, Xiaoyun Liu², Zhongrui Yan³, Bo Wu⁴, Baoquan Lu⁵, Beilei Chen⁶, Daishi Tian⁷, Ailian Du⁸, Litao Li⁹, Changyun Liu¹⁰, Guangzhi Liu¹¹, Tao Gong¹², Zhimin Shi¹³, Feng Feng¹⁴, Caiyan Liu¹, Yao Meng¹⁵, Qianqian Lin¹⁶, Mingli Li¹⁴, Wei-Hai Xu¹

Affiliations

¹ State Key Laboratory of Complex Severe and Rare Diseases, Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
³ Department of Neurology, Jining No. 1 People's Hospital, Jining, China.
⁴ Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
⁵ Department of Neurology, Tangshan Gongren Hospital, Tangshan, China.
⁶ Department of Neurology, Subei People's Hospital of Jiangsu Province, Yangzhou, China.
⁷ Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁸ Department of Neurology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁹ Department of Neurology, Hebei General Hospital, Shijiazhuang, China.
¹⁰ Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China.
¹¹ Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
¹² Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China.
¹³ Department of Neurology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China.
¹⁴ Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
¹⁵ Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
¹⁶ Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China.

PMID: 38229443
DOI: 10.1177/17474930241228203

Abstract

Background: High-resolution magnetic resonance vessel wall imaging (HRMR-VWI) is a promising technique for identifying intracranial vulnerable plaques beyond lumen narrowing. However, the association between HRMR-VWI characteristics and recurrent stroke remains uncertain.

Aims: This study aimed to investigate the association between HRMR-VWI characteristics and recurrent ipsilateral stroke in patients with symptomatic intracranial atherosclerotic steno-occlusive disease (ICAS).

Methods: This multicenter, observational study recruited first-ever acute ischemic stroke patients attributed to ICAS (>50% stenosis or occlusion) within 7 days after onset. Participants were assessed by multiparametric magnetic resonance imaging (MRI) including diffusion-weighted imaging, three-dimension time-of-flight magnetic resonance angiography, and three-dimensional T1-weighted HRMR-VWI. The patients were recommended to receive best medical therapy and were systematically followed up for 12 months. The association between HRMR-VWI characteristics and the time to recurrent ipsilateral stroke was investigated by univariable and multivariable analysis.

Results: Two hundred and fifty-five consecutive patients were enrolled from 15 centers. The cumulative 12 month ipsilateral recurrence incidence was 4.1% (95% confidence interval (CI): 1.6-6.6%). Patients with recurrent ipsilateral stroke exhibited higher rates of intraplaque hemorrhage (IPH) (30.0% vs 6.5%) and eccentric plaque (90.0% vs 48.2%), and lower occurrence of occlusive thrombus (10.0% vs 23.7%). Plaque length (5.69 ± 2.21 mm vs 6.67 ± 4.16 mm), plaque burden (78.40 ± 7.37% vs 78.22 ± 8.32%), degree of stenosis (60.25 ± 18.95% vs 67.50% ± 22.09%) and remodeling index (1.07 ± 0.27 vs 1.03 ± 0.35) on HRMR-VWI did not differ between patients with and without recurrent ipsilateral stroke. In the multivariable Cox regression analysis, IPH (hazard ratio: 6.64, 95% CI: 1.23-35.8, p = 0.028) was significantly associated with recurrent ipsilateral stroke after adjustment.Conclusions:Our results suggest intraplaque hemorrhage (IPH) is significantly associated with recurrent ipsilateral stroke and has potential value in the selection of patients for aggressive treatment strategies.

Data access statement: Data from this study are available and can be accessed upon request.

Keywords: High-resolution magnetic resonance vessel wall imaging; intracranial atherosclerotic steno-occlusive disease; intraplaque hemorrhage.