Analysis of prognostic factors in stroke patients with symptomatic intracranial vascular stenosis based on high resolution MR vessel wall imaging

YU Huan; DUAN Kai; ZHANG Yue; SONG Chunhua; BO Wenwei; HAN Liping; ZHANG Tie

doi:10.19300/j.2017.L5581zt

Abstract：Objective Based on MR high resolution vessel wall imaging technique, the risk factors of prognosis in patients with symptomatic intracranial vascular stenosis were investigated. Methods Thirty four patients who diagnosed stroke with symptomatic intracranial vascular stenosis at the Department of Neurology in our hospital during January 2016 to March 2017 were retrospectively selected. The imaging features of intracranial plaques were analyzed with MR high resolution vessel wall imaging. Based on the modified Rankin scale (mRS) 3 months after discharge, the patients were divided into good prognosis and poor prognosis groups. The clinical data, plaque stability and plaque composition of the 2 groups were compared by t test or Fisher exact probability test. The independent risk factors of the poor prognosis were analyzed by Logistic regression. Results There were significant differences in the history of diabetes, the history of hypertension, lumen stenosis rate>50%, and the stability of plaques between the 2 groups (P<0.05). The percentage of poor prognosis in the unstable plaque group was higher than that of plaque stable group (78% vs. 22%); the percentage of good prognosis in unstable plaque group was lower than the plaque stable group (36%vs. 64%). There was significant difference in plaque stability between the 2 groups (P=0.031). The proportion of intraplaque hemorrhage and necrosis of the lipid core was significantly higher in the poor prognosis group than the good prognosis group (P<0.05);the presence of calcification plaque and lumen stenosis rate>50%did not significantly differ between poor and good prognosis groups (P>0.05). The history of hypertension, history of diabetes, degree of intracranial stenosis, and the stability of plaques were the independent risk factors for the poor prognosis of stroke. Conclusion High resolution MR vessel wall imaging technique is of great value in evaluating the prognosis of stroke patients with symptomatic intracranial vascular stenosis. Hypertension, diabetes mellitus, intracranial arterial stenosis, and plaque stability might be independent risk factors for the poor prognosis of stroke. Among that, the degree of intracranial arterial stenosis and the stability of plaque are the two most important factors.