Acute ischemic stroke versus transient ischemic attack: Differential plaque morphological features in symptomatic intracranial atherosclerotic lesions - PubMed (original) (raw)

doi: 10.1016/j.atherosclerosis.2021.01.002. Epub 2021 Jan 11.

Matthew M Padrick 2, Tao Jiang 3, Shuang Xia 4, Fang Wu 5, Yu Guo 4, Nestor R Gonzalez 6, Shujuan Li 7, Konrad H Schlick 2, Oana M Dumitrascu 2, Marcel M Maya 8, Marcio A Diniz 9, Shlee S Song 2, Patrick D Lyden 2, Debiao Li 1, Qi Yang 10, Zhaoyang Fan 11

Affiliations

Acute ischemic stroke versus transient ischemic attack: Differential plaque morphological features in symptomatic intracranial atherosclerotic lesions

Jiayu Xiao et al. Atherosclerosis. 2021 Feb.

Abstract

Background and aims: Intracranial atherosclerotic disease (ICAD) is a major etiologic cause for acute ischemic stroke (AIS) and transient ischemic attack (TIA). The study was designed to investigate if differential morphological features exist in symptomatic atherosclerotic lesions between AIS and TIA patients.

Methods: The culprit plaques from 45 AIS patients and 42 TIA patients were analyzed for the degree of stenosis, vessel wall irregularity, normalized wall index (NWI), remodeling index, plaque-wall contrast ratio (CR), high signal intensity on T1-weighted images, plaque enhancement ratio and enhancement grade. These plaque features along with clinical characteristics were compared between AIS and TIA groups as well as between their stenosis degree-matched subgroups.

Results: Overall, grade 2 enhancement (OR 3.85, 95%CI 1.42-10.46, p = 0.006) and hyperlipidemia (OR 3.04, 95%CI 1.13-8.22, p = 0.025) were independent indicators for AIS, whereas high NWI (OR 1.47, 95%CI 0.76-2.86, p = 0.004) was associated with TIA. In the comparison between the subgroups with moderate (30%-69%) stenosis, high plaque-wall CR (OR 5.38, 95%CI 1.39-20.75, p = 0.008) was associated with AIS, whereas high NWI (OR 2.50, 95%CI 0.61-10.00, p = 0.006) was associated with TIA.

Conclusions: Our study reveals differential morphological features in symptomatic ICAD lesions between AIS and TIA patients. Probing these features with MR vessel wall imaging may provide insights into the prognosis of patients with ICAD.

Keywords: Intracranial atherosclerosis; Ischemic stroke; MRI; Transient ischemic attack.

Copyright © 2021 Elsevier B.V. All rights reserved.

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Conflict of interest statement

Declaration of competing interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1.

Fig 1.

Flowchart of the study population. MCA: middle cerebral artery; MRA: magnetic resonance angiography; TIA: transient ischemic attack; DWI: diffusion weighted imaging; AIS: acute ischemic stroke.

Fig 2.

Fig 2.

A representative case of AIS patients. A 60-year-old man with hypertension and hyperlipidemia who was diagnosed with stroke 2 days before MRI scan. (A) DWI showed high signal intensity lesions on the right corona radiata. (B) A moderate stenosis was found on the right middle cerebral artery (MCA) M1–M2 bifurcation in MRA. Curved multiplanar reconstructions of pre-(C) and post-contrast (D) MR-VWI showed a focal plaque on the right MCA with moderate stenosis, regular plaque surface, intermediate remodeling (remodeling index = 0.97) and grade 2 enhancement (plaque enhancement ratio = 1.52). The plaque-wall contrast ratio and normalized wall index were 1.85, 0.70, respectively.

Fig 3.

Fig 3.

A representative case of TIA patients. A 27-year-old female patient with hyperlipidemia who developed symptoms of paroxysmal left upper extremity weakness was diagnosed with TIA 3 days before MRI scan. (A) No diffusion-restricted lesion was found in DWI. (B) A moderate stenosis was found on the right middle cerebral artery (MCA) M1 in MRA. Curved multiplanar reconstructions of pre-(C) and post-contrast (D) MR-VWI showed a focal plaque on the right MCA with moderate stenosis, regular plaque surface, negative remodeling (remodeling index = 0.83) and grade 1 enhancement (plaque enhancement ratio = 1.27). The plaque-wall contrast ratio and normalized wall index were 1.42, 0.78, respectively.

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