Objective Intensive medical management has been recommended for ischemic stroke of intracranial atherosclerosis (ICAS), but 9.4–15% probability of recurrent stroke remains an inevitable reality. The characteristics of high-risk intracranial plaque that contribute to stroke recurrence after intensive therapy are unclear. Methods The patients of acute ischemic stroke due to ICAS from two centers were prospectively analyzed, who underwent the 3D high-resolution head and neck vessel wall magnetic resonance imaging (hr-VW-MRI) at baseline and received intensive medical management within 90 days. The morphological features, such as minimal lumen area (MLA), and histogram parameters including entropy were assessed based on hr-VW-MR images. The recurrence of ischemic events after 6 months was defined as hyperintensity on diffusion-weighted images in the ipsilateral vascular territory. Cox regression analysis was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for recurrent events. Results A total of 222 patients (age 59.5 ± 12.1; males 153) were finally included, and 38 had recurrent stroke after 6 months. After adjusting the age and gender, Cox regression demonstrated that smoking (HR = 4.321; 95% CI, 1.838–10.161; p = 0.001), taking exercise (HR = 0.409; 95% CI, 0.198–0.843; p = 0.015), blood pressure management (HR = 0.180; 95% CI, 0.073–0.443; p = 0.001), MLA (HR = 0.771; 95% CI, 0.625–0.951; p = 0.015) and entropy (HR = 0.274; 95% CI, 0.130–0.576; p = 0.001) were significant predictors of recurrent ischemic stroke. However, the area under curve value of MRI parameters was significantly higher than that of traditional clinical factors (0.86 vs 0.79; p = 0.01). Conclusions The plaque characteristics based on hr-VW-MRI may provide complementary values over traditional clinical features in predicting ischemic recurrence for ICAS. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> The study addresses recurrent ischemic stroke in intracranial atherosclerosis patients, identifying high-risk plaque features that contribute to recurrence despite intensive medical management. <Emphasis Type="BoldItalic">Findings</Emphasis> Plaque features on high-resolution vessel wall magnetic resonance imaging (hr-VW-MRI), such as minimal lumen area and entropy, improve prediction of stroke recurrence over clinical factors. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> This two-center prospective study improves patient care by using hr-VW-MRI and histogram factors like entropy to better predict stroke recurrence, allowing for more personalized treatment strategies and potentially reducing ischemic events in patients with intracranial atherosclerosis. Graphical Abstract

High-risk characteristics of recurrent ischemic stroke after intensive medical management for 6-month follow-up: a histogram study on vessel wall MRI

期刊论文
发表日期：

2025年1月2日

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Zhang Shi,
Boyu Zhang,
Xiyin Miao,
Shujie Zhang,
Jing Li,
Qi Liu,
Mengsu Zeng,
Jiang Lin,
Jianping Lu,
He Wang

摘要

Objective

Intensive medical management has been recommended for ischemic stroke of intracranial atherosclerosis (ICAS), but 9.4–15% probability of recurrent stroke remains an inevitable reality. The characteristics of high-risk intracranial plaque that contribute to stroke recurrence after intensive therapy are unclear.

Methods

The patients of acute ischemic stroke due to ICAS from two centers were prospectively analyzed, who underwent the 3D high-resolution head and neck vessel wall magnetic resonance imaging (hr-VW-MRI) at baseline and received intensive medical management within 90 days. The morphological features, such as minimal lumen area (MLA), and histogram parameters including entropy were assessed based on hr-VW-MR images. The recurrence of ischemic events after 6 months was defined as hyperintensity on diffusion-weighted images in the ipsilateral vascular territory. Cox regression analysis was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for recurrent events.

Results

A total of 222 patients (age 59.5 ± 12.1; males 153) were finally included, and 38 had recurrent stroke after 6 months. After adjusting the age and gender, Cox regression demonstrated that smoking (HR = 4.321; 95% CI, 1.838–10.161; p = 0.001), taking exercise (HR = 0.409; 95% CI, 0.198–0.843; p = 0.015), blood pressure management (HR = 0.180; 95% CI, 0.073–0.443; p = 0.001), MLA (HR = 0.771; 95% CI, 0.625–0.951; p = 0.015) and entropy (HR = 0.274; 95% CI, 0.130–0.576; p = 0.001) were significant predictors of recurrent ischemic stroke. However, the area under curve value of MRI parameters was significantly higher than that of traditional clinical factors (0.86 vs 0.79; p = 0.01).

Conclusions

The plaque characteristics based on hr-VW-MRI may provide complementary values over traditional clinical features in predicting ischemic recurrence for ICAS.

Key Points

Question The study addresses recurrent ischemic stroke in intracranial atherosclerosis patients, identifying high-risk plaque features that contribute to recurrence despite intensive medical management.

Findings Plaque features on high-resolution vessel wall magnetic resonance imaging (hr-VW-MRI), such as minimal lumen area and entropy, improve prediction of stroke recurrence over clinical factors.

Clinical relevance This two-center prospective study improves patient care by using hr-VW-MRI and histogram factors like entropy to better predict stroke recurrence, allowing for more personalized treatment strategies and potentially reducing ischemic events in patients with intracranial atherosclerosis.

Graphical Abstract