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Abstract：
OBJECTIVE: To evaluate the predictive ability of plaque characteristics for long-term stroke recurrence among patients with symptomatic intracranial atherosclerotic disease (ICAD).
METHODS: This cohort study included 132 patients with acute ischemic stroke (AIS) attributed to ICAD who were recruited between July 2017 and December 2020 and followed until stroke recurrence or December 2021. Plaque surface irregularity, degree of stenosis, plaque burden, remodeling ratio, enhancement ratio, and intraplaque hemorrhage were assessed with 3-dimensional high-resolution magnetic resonance vessel wall imaging (3D HR-MRI). Data were analyzed using Cox models, receiver operating characteristic (ROC) curves, and Kaplan-Meier survival analysis.
RESULTS: Of the 132 patients, during a median follow-up of 2.8 years, stroke recurrence occurred in 35 patients. The multivariable-adjusted hazard ratio (95% confidence interval) of stroke recurrence was 3.15 (1.34-7.42) per 10% increase in plaque burden and 2.17 (1.27-3.70) for enhancement ratio. The area under the curve (AUC) to predict stroke recurrence was 0.725 (95% CI 0.629-0.822) for plaque burden, 0.692 (95% CI 0.593-0.792) for enhancement ratio, and only 0.595 (95% CI 0.492-0.699) for the Essen stroke risk score. The Kaplan-Meier survival analysis further demonstrated significant differences in survival of free recurrent stroke between patients with plaque burden or enhancement ratio below and above the optimum cut-offs (both p < 0.001).
CONCLUSIONS: Higher plaque burden and enhancement ratio are independent risk factors for long-term stroke recurrence among patients with symptomatic ICAD, and valuable imaging markers for predicting and stratifying risk of stroke recurrence.
CONCLUSIONS: In patients with symptomatic ICAD, the results of this high-resolution magnetic resonance vessel wall imaging study have potential implications for optimal management of intracranial plaques and secondary prevention of stroke recurrence based on plaque burden and enhancement ratio.
CONCLUSIONS: • Identification of intracranial plaque characteristics responsible for stroke recurrence is essential to preventing stroke recurrence in patients with symptomatic intracranial atherosclerotic disease. • Higher plaque burden and enhancement ratio are independent risk factors for stroke recurrence. • Plaque burden and enhancement ratio are valuable imaging markers in the prediction and stratification of the risk of stroke recurrence.
METHODS: This cohort study included 132 patients with acute ischemic stroke (AIS) attributed to ICAD who were recruited between July 2017 and December 2020 and followed until stroke recurrence or December 2021. Plaque surface irregularity, degree of stenosis, plaque burden, remodeling ratio, enhancement ratio, and intraplaque hemorrhage were assessed with 3-dimensional high-resolution magnetic resonance vessel wall imaging (3D HR-MRI). Data were analyzed using Cox models, receiver operating characteristic (ROC) curves, and Kaplan-Meier survival analysis.
RESULTS: Of the 132 patients, during a median follow-up of 2.8 years, stroke recurrence occurred in 35 patients. The multivariable-adjusted hazard ratio (95% confidence interval) of stroke recurrence was 3.15 (1.34-7.42) per 10% increase in plaque burden and 2.17 (1.27-3.70) for enhancement ratio. The area under the curve (AUC) to predict stroke recurrence was 0.725 (95% CI 0.629-0.822) for plaque burden, 0.692 (95% CI 0.593-0.792) for enhancement ratio, and only 0.595 (95% CI 0.492-0.699) for the Essen stroke risk score. The Kaplan-Meier survival analysis further demonstrated significant differences in survival of free recurrent stroke between patients with plaque burden or enhancement ratio below and above the optimum cut-offs (both p < 0.001).
CONCLUSIONS: Higher plaque burden and enhancement ratio are independent risk factors for long-term stroke recurrence among patients with symptomatic ICAD, and valuable imaging markers for predicting and stratifying risk of stroke recurrence.
CONCLUSIONS: In patients with symptomatic ICAD, the results of this high-resolution magnetic resonance vessel wall imaging study have potential implications for optimal management of intracranial plaques and secondary prevention of stroke recurrence based on plaque burden and enhancement ratio.
CONCLUSIONS: • Identification of intracranial plaque characteristics responsible for stroke recurrence is essential to preventing stroke recurrence in patients with symptomatic intracranial atherosclerotic disease. • Higher plaque burden and enhancement ratio are independent risk factors for stroke recurrence. • Plaque burden and enhancement ratio are valuable imaging markers in the prediction and stratification of the risk of stroke recurrence.
摘要：
目的：评价斑块特征对症状性颅内动脉粥样硬化性疾病（ICAD）患者远期卒中复发的预测能力。
方法：该队列研究纳入了132例归因于ICAD的急性缺血性卒中（AIS）患者，这些患者于2017年7月至2020年12月期间招募，随访至卒中复发或2021年12月。斑块表面不规则性,狭窄程度,斑块负荷，重塑率，增强率，使用3维高分辨率磁共振血管壁成像(3DHR-MRI)评估斑块内出血.使用Cox模型分析数据，接收机工作特性(ROC)曲线，和Kaplan-Meier生存分析。
结果：在132名患者中，在2.8年的中位随访期间，35例患者发生卒中复发.卒中复发的多变量校正风险比（95％置信区间）为3.15（1.34-7.42），斑块负荷每增加10％为2.17（1.27-3.70）。斑块负荷预测卒中复发的曲线下面积(AUC)为0.725(95%CI0.629-0.822),增强率0.692（95%CI0.593-0.792），Essen卒中风险评分仅为0.595（95%CI0.492-0.699）。Kaplan-Meier生存分析进一步证明了斑块负荷或增强率低于和高于最佳截止值的患者在自由复发性卒中的生存方面存在显著差异(均p<0.001)。
结论：在有症状的ICAD患者中，较高的斑块负荷和增强率是长期卒中复发的独立危险因素。和有价值的影像学标记物，用于预测和分层卒中复发的风险。
结论：在有症状的ICAD患者中，这项高分辨率磁共振血管壁成像研究的结果对于颅内斑块的最佳管理和基于斑块负荷和增强比的卒中复发二级预防具有潜在意义.
结论：•识别导致卒中复发的颅内斑块特征对于预防有症状的颅内动脉粥样硬化性疾病患者的卒中复发至关重要。•较高的斑块负荷和增强比率是卒中复发的独立危险因素。•斑块负担和增强比率是预测和分层中风复发风险的有价值的成像标记。
方法：该队列研究纳入了132例归因于ICAD的急性缺血性卒中（AIS）患者，这些患者于2017年7月至2020年12月期间招募，随访至卒中复发或2021年12月。斑块表面不规则性,狭窄程度,斑块负荷，重塑率，增强率，使用3维高分辨率磁共振血管壁成像(3DHR-MRI)评估斑块内出血.使用Cox模型分析数据，接收机工作特性(ROC)曲线，和Kaplan-Meier生存分析。
结果：在132名患者中，在2.8年的中位随访期间，35例患者发生卒中复发.卒中复发的多变量校正风险比（95％置信区间）为3.15（1.34-7.42），斑块负荷每增加10％为2.17（1.27-3.70）。斑块负荷预测卒中复发的曲线下面积(AUC)为0.725(95%CI0.629-0.822),增强率0.692（95%CI0.593-0.792），Essen卒中风险评分仅为0.595（95%CI0.492-0.699）。Kaplan-Meier生存分析进一步证明了斑块负荷或增强率低于和高于最佳截止值的患者在自由复发性卒中的生存方面存在显著差异(均p<0.001)。
结论：在有症状的ICAD患者中，较高的斑块负荷和增强率是长期卒中复发的独立危险因素。和有价值的影像学标记物，用于预测和分层卒中复发的风险。
结论：在有症状的ICAD患者中，这项高分辨率磁共振血管壁成像研究的结果对于颅内斑块的最佳管理和基于斑块负荷和增强比的卒中复发二级预防具有潜在意义.
结论：•识别导致卒中复发的颅内斑块特征对于预防有症状的颅内动脉粥样硬化性疾病患者的卒中复发至关重要。•较高的斑块负荷和增强比率是卒中复发的独立危险因素。•斑块负担和增强比率是预测和分层中风复发风险的有价值的成像标记。
