Abstract：
Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke in China, but the prevalence and prognosis of asymptomatic ICAD detected using high-resolution magnetic resonance imaging (HR-MRI) is largely unknown. The aim of this study was to investigate the prevalence and prognosis in order to guide neurologists in interpreting ICAD detected on HR-MRI.
We included stroke-free participants from a community-based prospective cohort (Shunyi study participants) who underwent HR-MRI between July 2014 and April 2016. The participants were divided into two groups: those with or without ICAD (ICAD+ and ICAD- , respectively). ICAD included intracranial artery stenosis and non-stenotic plaque. The primary outcome was ischemic stroke. Cox proportional hazard models were used to evaluate the association between ICAD and event outcomes.
A total of 1060 stroke-free participants evaluated by HR-MRI were included from the Shunyi study. The median age at HR-MRI was 56 years and 64.7% were female. The ICAD prevalence was 36.3% (n = 385). The ICAD+ group was older and had more cerebrovascular risk factors. The rates of ischemic stroke in the ICAD- and ICAD+ groups were 1.3% (n = 9) and 5.2% (n = 20), respectively, with a median follow-up time of 54 months. ICAD was associated with an increased risk of ischemic stroke in the unadjusted and adjusted Cox models, with hazard ratios of 4.12 (95% confidence interval [CI] 1.87-9.05) and 2.50 (95% CI 1.05-5.94), respectively. The greatest risk of an event outcome was observed in participants with ≥70% stenosis or occlusion. The features of high-risk plaques were also identified.
We found that ICAD detected using HR-MRI increases the long-term risk of a first-ever ischemic stroke in a stroke-free population, suggesting that the current primary prevention protocol of stroke awaits further optimization.
We included stroke-free participants from a community-based prospective cohort (Shunyi study participants) who underwent HR-MRI between July 2014 and April 2016. The participants were divided into two groups: those with or without ICAD (ICAD+ and ICAD- , respectively). ICAD included intracranial artery stenosis and non-stenotic plaque. The primary outcome was ischemic stroke. Cox proportional hazard models were used to evaluate the association between ICAD and event outcomes.
A total of 1060 stroke-free participants evaluated by HR-MRI were included from the Shunyi study. The median age at HR-MRI was 56 years and 64.7% were female. The ICAD prevalence was 36.3% (n = 385). The ICAD+ group was older and had more cerebrovascular risk factors. The rates of ischemic stroke in the ICAD- and ICAD+ groups were 1.3% (n = 9) and 5.2% (n = 20), respectively, with a median follow-up time of 54 months. ICAD was associated with an increased risk of ischemic stroke in the unadjusted and adjusted Cox models, with hazard ratios of 4.12 (95% confidence interval [CI] 1.87-9.05) and 2.50 (95% CI 1.05-5.94), respectively. The greatest risk of an event outcome was observed in participants with ≥70% stenosis or occlusion. The features of high-risk plaques were also identified.
We found that ICAD detected using HR-MRI increases the long-term risk of a first-ever ischemic stroke in a stroke-free population, suggesting that the current primary prevention protocol of stroke awaits further optimization.
摘要：
目的：颅内动脉粥样硬化性疾病（ICAD）是中国缺血性卒中的主要原因，但高分辨率磁共振成像(HR-MRI)检测到的无症状性ICAD的患病率和预后在很大程度上未知.这项研究的目的是调查患病率和预后，以指导神经科医生解释在HR-MRI上检测到的ICAD。
方法：我们纳入了2014年7月至2016年4月期间接受HR-MRI检查的社区前瞻性队列（顺义研究参与者）中的无卒中参与者。参与者分为两组：有或没有ICAD（ICAD+和ICAD-，分别)。ICAD包括颅内动脉狭窄和非狭窄斑块。主要结果是缺血性卒中。Cox比例风险模型用于评估ICAD与事件结局之间的关联。
结果：从顺义研究中纳入了通过HR-MRI评估的1060名无卒中参与者。HR-MRI的中位年龄为56岁，64.7%为女性。ICAD患病率为36.3%(n=385)。ICAD+组年龄较大，脑血管危险因素较多。ICAD-组和ICAD+组的缺血性卒中发生率分别为1.3%(n=9)和5.2%(n=20),分别,中位随访时间为54个月。在未调整和调整的Cox模型中，ICAD与缺血性卒中风险增加相关。风险比为4.12（95%置信区间[CI]1.87-9.05）和2.50（95%CI1.05-5.94），分别。在≥70%狭窄或闭塞的参与者中观察到事件结局的最大风险。还鉴定了高风险斑块的特征。
结论：我们发现使用HR-MRI检测到的ICAD会增加无卒中人群中首次发生缺血性卒中的长期风险，提示当前卒中一级预防方案有待进一步优化.
方法：我们纳入了2014年7月至2016年4月期间接受HR-MRI检查的社区前瞻性队列（顺义研究参与者）中的无卒中参与者。参与者分为两组：有或没有ICAD（ICAD+和ICAD-，分别)。ICAD包括颅内动脉狭窄和非狭窄斑块。主要结果是缺血性卒中。Cox比例风险模型用于评估ICAD与事件结局之间的关联。
结果：从顺义研究中纳入了通过HR-MRI评估的1060名无卒中参与者。HR-MRI的中位年龄为56岁，64.7%为女性。ICAD患病率为36.3%(n=385)。ICAD+组年龄较大，脑血管危险因素较多。ICAD-组和ICAD+组的缺血性卒中发生率分别为1.3%(n=9)和5.2%(n=20),分别,中位随访时间为54个月。在未调整和调整的Cox模型中，ICAD与缺血性卒中风险增加相关。风险比为4.12（95%置信区间[CI]1.87-9.05）和2.50（95%CI1.05-5.94），分别。在≥70%狭窄或闭塞的参与者中观察到事件结局的最大风险。还鉴定了高风险斑块的特征。
结论：我们发现使用HR-MRI检测到的ICAD会增加无卒中人群中首次发生缺血性卒中的长期风险，提示当前卒中一级预防方案有待进一步优化.
