A high-resolution vascular wall imaging study of differences in risk factors for recurrence of intracranial atherosclerotic stroke in anterior and posterior circulation

WANG Xuelian; YUAN Tao; WANG Fei; LIU Xincheng; QUAN Guanmin

doi:10.19300/j.2024.L20717

Abstract：Objective To explore the difference of plaque characteristics based on high-resolution vascular wall imaging(HR-VWI)in predicting recurrence between anterior and posterior circulation ischemic stroke(ACIS and PCIS).Methods We retrospectively analyzed the HR-VWI,clinical,and conventional MRI data of 166 patients with atherosclerotic ischemic stroke(IS).The infarction locations were divided into ACIS and PCIS.During the follow-up period,the patients were categorized into a recurrent group(ACIS,25 cases;PCIS,11 cases)if IS reappeared in the original responsible blood supply area,and a non-recurrent group(ACIS,98 cases;PCIS,32 cases)if not.The Chi-square test,t test,and Mann Whitney U test were used to analyze the differences in clinical and imaging risk factors between the ACIS and PCIS patients in the recurrence group and non-recurrence group.The multivariate Cox regression analysis was used to determine the independent risk factors associated with recurrence of ACIS and PCIS.Area under the curve(AUC)of receiver operating characteristic(ROC)curve was employed to analyze the performance of various clinical and imaging factors in predicting IS recurrence.Results Compared with the non-recurrent group,the recurrent group had fewer male patients,older age,a higher incidence of multiple infarcts,plaque significant enhancement,and plaque surface irregularities in the ACIS group(P<0.05).Compared with the non-recurrent group,the recurrent group had a higher prevalence of diabetes,National Institute of Health Stroke Scale score,and the incidence of intraplaque hemorrhage(IPH)in the PCIS group(P<0.05).Age(>55.5 years),multiple infarcts,and plaque significant enhancement were independent risk factors for ACIS recurrence.Whereas diabetes and IPH were independent risk factors for PCIS recurrence.ROC analysis showed that areas under the curve(AUC)of age(>55.5 years),multiple infarcts,and plaque significant enhancement for predicting ACIS recurrence were 0.699,0.664,and 0.619,respectively,while the combined three indexes was 0.821,the sensitivity was 92.0%and the specificity was 67.3%.The AUC of diabetes and IPH for predicting PCIS recurrence were 0.692 and 0.678,respectively,while the combined two indexes was 0.770,the sensitivity was 72.7%and specificity was 65.6%.Conclusion The independent risk factors for recurrence of ACIS and PCIS are different.Plaque characteristics observed through HR-VWI,when combined with common risk factors,contribute to enhanced predictive accuracy for IS recurrence.