Atherosclerotic plaque evolution predicts cerebral ischemic events in patients with intracranial atherosclerosis: a multicentre longitudinal study using high-resolution MRI - Report - MDSpire
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Atherosclerotic plaque evolution predicts cerebral ischemic events in patients with intracranial atherosclerosis: a multicentre longitudinal study using high-resolution MRI
Progression of Intracranial Atherosclerotic Plaque Predicts Cerebral Ischemic Events
Overview
This multicenter longitudinal study using high-resolution MRI demonstrated that progression of intracranial atherosclerotic plaque in the middle cerebral artery is significantly associated with increased risk of subsequent ipsilateral cerebral ischemic events. Detailed vessel wall imaging parameters, beyond luminal stenosis, provide important prognostic information for patients with intracranial atherosclerosis.
Background
Intracranial atherosclerosis stenosis (ICAS) is a leading cause of ischemic stroke worldwide, particularly in East Asian populations, with the middle cerebral artery commonly affected. Despite optimal medical therapy, patients with symptomatic ICAS face a high risk of recurrent ischemic events. Traditional risk assessment relies mainly on luminal stenosis, but recent evidence suggests that plaque morphology and composition assessed by high-resolution magnetic resonance vessel wall imaging (hrMRI) offer superior prognostic value. However, longitudinal data on plaque evolution and its clinical significance in ICAS remain limited.
Data Highlights
Parameter
Definition/Measurement
Stenosis rate (%)
(1 - diameter of stenotic artery / diameter of proximal normal artery) × 100%
Minimum luminal area (MLA)
Area of lumen at most stenotic site
Vessel area (VA)
Area within vessel outer wall at stenotic site
Reference area (RA)
Area of nearby disease-free vessel segment
Plaque burden (PB)
(VA_MLA - LA_MLA) / VA_MLA
Remodeling index
VA_MLA / VA_RA
Eccentricity index
(WT_max - WT_min) / WT_max; eccentric plaque if > 0.5
Intraplaque hemorrhage (IPH)
Hyperintensity on T1WI with lesion signal ≥1.5× brain parenchyma
Plaque enhancement ratio
Lesion enhancement signal / brain parenchyma signal on CE-T1WI; enhancement if >1.5
Key Findings
Progression of intracranial atherosclerotic plaque features on hrMRI is significantly associated with increased risk of ipsilateral ischemic stroke or TIA.
Traditional luminal stenosis measurement alone is insufficient to predict recurrent ischemic events in ICAS patients.
High-risk plaque characteristics include plaque enhancement, eccentricity, and presence of intraplaque hemorrhage.
Longitudinal changes in plaque burden and vessel wall parameters provide stronger prognostic value than cross-sectional assessments.
Multicenter data confirm the feasibility and reproducibility of hrMRI for monitoring plaque evolution in clinical practice.
Clinical Implications
Incorporating high-resolution vessel wall imaging into routine evaluation of patients with intracranial atherosclerosis can improve risk stratification beyond luminal stenosis assessment. Monitoring plaque progression over time may identify patients at higher risk for recurrent ischemic events who could benefit from intensified medical therapy or closer surveillance. This approach supports personalized management strategies in ICAS.
Conclusion
This study highlights the prognostic importance of intracranial atherosclerotic plaque progression assessed by hrMRI in predicting cerebral ischemic events. Longitudinal vessel wall imaging offers valuable insights for optimizing risk assessment and guiding treatment in ICAS patients.
References
Wang et al. 2024 -- Progression of Atherosclerotic Plaque as a Predictor of Cerebral Ischemic Events in Patients with Intracranial Atherosclerosis
