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.

UNASSIGNED: The correlation between percutaneous coronary intervention (PCI)-related microvascular dysfunction (MVD) and plaque characteristics remains unclear. To investigate this correlation and its prognosis, we assessed changes in MVD by angiographic microvascular resistance (AMR) and intracoronary ultrasound scans after PCI.
UNASSIGNED: We conducted a retrospective study that enrolled 250 patients with coronary artery disease between July 2016 and December 2018. We collected demographic characteristics, laboratory tests, coronary angiography (CAG) and intracoronary ultrasound findings. We calculated quantitative flow ratio (QFR) and AMR by CAG. The endpoint was vessel-oriented composite outcomes (VOCOs).
UNASSIGNED: After 47 exclusions, we divided 203 cases into a deteriorated group (n=139) and an improved group (n=64) based on AMR change after PCI. Compared with the improved group, the deteriorated group had smaller lumen area [3.03 (interquartile range, 2.20-3.91) vs. 3.55 mm2 (interquartile range, 2.45-4.57), P=0.033], higher plaque burden [78.92% (interquartile range, 73.95-82.61%) vs. 71.93% (interquartile range, 62.70-77.51%), P<0.001], and higher proportion of lipidic components (13.86%±4.67% vs. 11.78%±4.41%, P=0.024). Of 186 patients who completed 4.81±1.55 years follow-up, 56 developed VOCOs. Receiver-operating characteristic (ROC) curve analysis showed post-PCI AMR and VOCOs correlation (area under the curve: 0.729, P<0.001). Multivariate regression analysis showed post-PCI AMR >285 mmHg·s/m correlated with adverse outcome (hazard ratio =4.350; 95% confidence interval: 1.95-9.703; P<0.001).
UNASSIGNED: Intravascular ultrasound (IVUS) imaging and AMR revealed an association of post-PCI MVD with a smaller lumen area, more severe plaque burden, and a higher percentage of lipidic components. Post-PCI MVD was an independent risk factor for poor prognosis.

OBJECTIVE: Coronary computed tomography angiography (CTA) and fractional flow reserve by computed tomography (FFR-CT) are increasingly utilized to characterize coronary artery disease (CAD). We evaluated the feasibility of distal-vessel FFR-CT as an integrated measure of epicardial CAD that can be followed serially, assessed the CTA parameters that correlate with distal-vessel FFR-CT, and determined the combination of clinical and CTA parameters that best predict distal-vessel FFR-CT and distal-vessel FFR-CT changes.
RESULTS: Patients (n = 71) who underwent serial CTA scans at ≥2 years interval (median = 5.2 years) over a 14-year period were included in this retrospective study. Coronary arteries were analysed blindly using artificial intelligence-enabled quantitative coronary CTA. Two investigators jointly determined the anatomic location and corresponding distal-vessel FFR-CT values at CT1 and CT2. A total of 45.3% had no significant change, 27.8% an improvement, and 26.9% a worsening in distal-vessel FFR-CT at CT2. Stepwise multiple logistic regression analysis identified a four-parameter model consisting of stenosis diameter ratio, lumen volume, low density plaque volume, and age, that best predicted distal-vessel FFR-CT ≤ 0.80 with an area under the curve (AUC) = 0.820 at CT1 and AUC = 0.799 at CT2. Improvement of distal-vessel FFR-CT was captured by a decrease in high-risk plaque and increases in lumen volume and remodelling index (AUC = 0.865), whereas increases in stenosis diameter ratio, medium density calcified plaque volume, and total cholesterol presaged worsening of distal-vessel FFR-CT (AUC = 0.707).
CONCLUSIONS: Distal-vessel FFR-CT permits the integrative assessment of epicardial atherosclerotic plaque burden in a vessel-specific manner and can be followed serially to determine changes in global CAD.

UNASSIGNED: To explore the potential of perivascular fat attenuation index (FAI) and coronary computed tomography angiography (CCTA) derived fractional flow reserve (CT-FFR) in the identification of culprit lesion leading to subsequent acute coronary syndrome (ACS).
UNASSIGNED: Thirty patients with documented ACS event who underwent invasive coronary angiography (ICA) from February 2019 to February 2021 and had received CCTA in the previous 6 months were collected retrospectively. 40 patients with stable angina pectoris (SAP) were matched as control group according to sex, age and risk factors. The study population has a mean age of 59.3 ± 12.3 years, with a male prevalence of 81.4%. The plaque characteristics, perivascular fat attenuation index (FAI), and coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) of 32 culprit lesions and 30 non-culprit lesions in ACS patients and 40 highest-grade stenosis lesions in SAP patients were statistically analyzed.
UNASSIGNED: FAI around culprit lesions was increased significantly (-72.4 ± 3.2 HU vs. -79.0 ± 7.7 HU, vs. -80.4 ± 7.0HU, all p < 0.001) and CT-FFR was decreased for culprit lesions of ACS patients [0.7(0.1) vs. 0.8(0.1), vs.0.8(0.1), p < 0.001] compared to other lesions. According to multivariate analysis, diameter stenosis (DS), FAI, and CT-FFR were significant predictors for identification of the culprit lesion. The integration model of DS, FAI, and CT-FFR showed the significantly highest area under the curve (AUC) of 0.917, compared with other single predictors (all p < 0.05).
UNASSIGNED: This study proposes a novel integrated prediction model of DS, FAI, and CT-FFR that enhances the diagnostic accuracy of traditional CCTA for identifying culprit lesions that trigger ACS. Furthermore, this model also provides improved risk stratification for patients and offers valuable insights for predicting future cardiovascular events.

UNASSIGNED: In-stent neoatherosclerosis has emerged as a crucial factor in post-stent complications including late in-stent restenosis and very late stent thrombosis. In this study, we investigated the ability of quantitative plaque characteristics from intravascular optical coherence tomography (IVOCT) images taken just prior to stent implantation to predict neoatherosclerosis after implantation.
UNASSIGNED: This was a sub-study of the TRiple Assessment of Neointima Stent FOrmation to Reabsorbable polyMer with Optical Coherence Tomography (TRANSFORM-OCT) trial. Images were obtained before and 18 months after stent implantation. Final analysis included images of 180 lesions from 90 patients; each patient had images of two lesions in different coronary arteries. A total of 17 IVOCT plaque features, including lesion length, lumen (e.g., area and diameter); calcium (e.g., angle and thickness); and fibrous cap (FC) features (e.g., thickness, surface area, and burden), were automatically extracted from the baseline IVOCT images before stenting using dedicated software developed by our group (OCTOPUS). The predictive value of baseline IVOCT plaque features for neoatherosclerosis development after stent implantation was assessed using univariate/multivariate logistic regression and receiver operating characteristic (ROC) analyses.
UNASSIGNED: Follow-up IVOCT identified stents with (n = 19) and without (n = 161) neoatherosclerosis. Greater lesion length and maximum calcium angle and features related to FC were associated with a higher prevalence of neoatherosclerosis after stent implantation (p < 0.05). Hierarchical clustering identified six clusters with the best prediction p-values. In univariate logistic regression analysis, maximum calcium angle, minimum calcium thickness, maximum FC angle, maximum FC area, FC surface area, and FC burden were significant predictors of neoatherosclerosis. Lesion length and features related to the lumen were not significantly different between the two groups. In multivariate logistic regression analysis, only larger FC surface area was strongly associated with neoatherosclerosis (odds ratio 1.38, 95% confidence interval [CI] 1.05-1.80, p < 0.05). The area under the ROC curve was 0.901 (95% CI 0.859-0.946, p < 0.05) for FC surface area.
UNASSIGNED: Post-stent neoatherosclerosis can be predicted by quantitative IVOCT imaging of plaque characteristics prior to stent implantation. Our findings highlight the additional clinical benefits of utilizing IVOCT imaging in the catheterization laboratory to inform treatment decision-making and improve outcomes.

Increasing evidence has suggested that plaque characteristics are closely associated with ischemia, and coronary computed tomography (CT) angiography-derived fractional flow reserve (FFRCT) based on deep machine learning algorithms has also been used to identify lesion-specific ischemia. Therefore, the aim of the present study was to explore the predictive ability of plaque characteristics in combination with deep learning-based FFRCT for lesion-specific ischemia. To meet this end, invasive FFR was used as a reference standard, with the joint aims of the early prediction of ischemic lesions and guiding clinical treatment. In the present study, the plaque characteristics, including non-calcified plaque (NCP), low-density NCP (LD-NCP), plaque length, total plaque volume (TPV), remodeling index, calcified plaque, fibrous plaque and plaque burden, were obtained using a semi-automated program. The FFRCT values were derived based on a deep machine learning algorithm. On the basis of the data obtained, differences among the values between the atopic ischemia and the non-significant lesions groups were analyzed to further determine the predictive value of independent predictors for atopic ischemia. Of the plaque features, FFRCT, LD-NCP, NCP, TPV and plaque length differed significantly when comparing between the lesion-specific ischemia and no hemodynamic abnormality groups, and LD-NCP and FFRCT were both independent predictors for ischemia. Additionally, FFRCT combined with LD-NCP showed a greater ability at discriminating ischemia compared with FFRCT or LD-NCP alone. Taken together, the findings of the present study suggest that the combination of FFRCT and LD-NCP has a synergistic effect in terms of predicting ischemia, thereby facilitating the identification of specific ischemia in patients with coronary artery disease.

BACKGROUND: Atherosclerosis is the most common cause of ischemia stroke. Computed tomographic angiography (CTA) and digital subtraction angiography (DSA) are used to evaluate the degree of lumen stenosis. However, these examinations are invasive and can only reveal mild to moderate stenosis. High-resolution magnetic resonance imaging (HRMRI) seems a more intuitive way to show the pathological changes of vascular wall. Hence, we conducted a systematic retrospective study to determine the characteristics of symptomatic plaques in patients with intracranial atherosclerosis on HRMRI and their association with the occurrence and recurrence of ischemic stroke events.
METHODS: The PubMed database was searched for relevant studies reported from January 31, 2010, to October 31, 2020.
RESULTS: We selected 14 clinical outcome studies. We found that plaque enhancement and positive remodeling on HRMRI indicate symptomatic plaques. Besides, intraplaque hemorrhage and positive remodeling index are closely related to the occurrence of stroke. However, it is still controversial whether the initial enhancement of plaque and the occurrence and recurrence of stroke are related. There is also no significant correlation between vascular stenosis and symptomatic plaque or the occurrence and recurrence of ischemic stroke.
CONCLUSIONS: High-resolution magnetic resonance imaging can be used as an assessment tool to predict the risk of stroke onset and recurrence in patients with atherosclerosis, but further research is also needed.

暂无摘要。

This study sought to evaluate the prognostic impact of plaque morphology and coronary physiology on outcomes after medical treatment or percutaneous coronary intervention (PCI).
Although fractional flow reserve (FFR) is currently best practice, morphological characteristics of coronary artery disease also contribute to outcomes.
A total of 872 vessels in 538 patients were evaluated by invasive FFR and coronary computed tomography angiography. High-risk attributes (HRA) were defined as high-risk physiological attribute (invasive FFR ≤0.8) and high-risk morphological attributes including: 1) local plaque burden (minimum lumen area <4 mm2 and plaque burden ≥70%); 2) adverse plaque characteristics ≥2; and 3) global plaque burden (total plaque volume ≥306.5 mm3 and percent atheroma volume ≥32.2%). The primary outcome was the composite of revascularization, myocardial infarction, or cardiac death at 5 years.
The mean FFR was 0.88 ± 0.08, and PCI was performed in 239 vessels. The primary outcome occurred in 54 vessels (6.2%). All high-risk morphological attributes were associated with the increased risk of adverse outcomes after adjustment for FFR ≤0.8 and demonstrated direct prognostic effect not mediated by FFR ≤0.8. The 5-year event risk proportionally increased as the number of HRA increased (p for trend <0.001) with lower risk in the PCI group than the medical treatment group in vessels with 1 or 2 HRA (9.7% vs. 14.7%), but not in vessels with either 0 or ≥3 HRA. Of the vessels with pre-procedural FFR ≤0.8, ischemia relief by PCI (pre-PCI FFR ≤0.8 and post-PCI FFR >0.8) significantly reduced vessel-oriented composite outcome risk compared with medical treatment alone in vessels with 0 or 1 high-risk morphological attributes (hazard ratio: 0.33; 95% confidence interval: 0.12 to 0.93; p = 0.035), but the risk reduction was attenuated in vessels with ≥2 high-risk morphological attributes.
High-risk morphological attributes offered additive prognostic value to coronary physiology and may optimize selection of treatment strategies by adding to FFR-based risk predictions (CCTA-FFR Registry for Development of Comprehensive Risk Prediction Model; NCT04037163).

OBJECTIVE: To evaluate the diagnostic performance of fractional flow reserve (FFR) derived from coronary computed tomography angiography (CCTA; CT-FFR) and combined plaque characteristics for ischemia in different CCTA stenosis levels.
METHODS: This clinical trial analyzed 317 patients with 30 %-90 % coronary stenosis in 366 vessels from 5 centers undergoing CCTA and invasive FFR. 366 vessels were assigned into < 50 % (nonobstructive) and ≥ 50 % (obstructive) stenosis groups. Lesion length (LL), plaque burden (PB), diameter stenosis (DS), volume ratio of plaque subcomponents < 30 HU (VR < 30HU), and high-risk features were analyzed. Logistic regression models were used to identify plaque characteristic predictors for lesion-specific ischemia in different stenosis grades. The area under receiver operating characteristics curve (AUC) of integrated plaque characteristics and CT-FFR were calculated and compared.
RESULTS: In < 50 % stenosis lesions, PB (OR: 1.296, p = 0.002), LL (OR:1.075, p = 0.020), and DS (OR:1.085, p = 0.031) were independent predictors of ischemia. In ≥ 50 % stenosis lesions, VR < 30HU (OR:1.031, p = 0.005) and DS (OR: 1.020, p =  0.044) were independent predictors for ischemia. AUC of plaque characteristic (VR < 30HU plus DS) for ischemia was 0.67 (95 % CI: 0.61-0.72) in ≥ 50 % stenosis level, which was significantly lower than CT-FFR (AUC=0.90; 95 % CI: 0.86-0.93) (p <  0.001). For lesions causing < 50 % stenosis, AUC of combined plaque model (VR < 30HU plus DS) was 0.88 (95 % CI: 0.80-0.95), equivalent to AUC of CT-FFR (AUC = 0.88; 95 % CI: 0.80-0.96; p =  0.957).
CONCLUSIONS: CT-FFR is a powerful functional assessment tool for both obstructive and nonobstructive diseases. However, for nonobstructive CAD confirmed by CCTA, a model of a combination of plaque characteristics could be a valuable alternative to CT-FFR.