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Co-existing intracranial and extracranial carotid atherosclerosis predicts large-artery atherosclerosis stroke recurrence: a single-center prospective study utilizing combined head-and-neck vessel wall imaging

  • Magnetic Resonance
  • Published:
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Abstract

Objectives

Intracranial and extracranial plaque features on high-resolution vessel wall imaging (HR-VWI) are associated with large-artery atherosclerosis (LAA) stroke recurrence. However, most studies have focused on a single vascular bed, and the prognostic value of combined intracranial and extracranial plaque features has yet to be studied. This study aimed to investigate the roles of plaque features, plaque number, and co-existing atherosclerosis in predicting stroke recurrence, utilizing combined head-and-neck HR-VWI.

Methods

From September 2016 to March 2020, participants with acute LAA ischemic strokes were prospectively enrolled and underwent combined head-and-neck HR-VWI. The participants were followed for stroke recurrence for at least 12 months or until a subsequent event occurred. The imaging features at baseline, including conventional and histogram plaque features, plaque number, and co-existing atherosclerosis, were evaluated. Univariable Cox regression analysis and the least absolute shrinkage and selection operator (lasso) method were used for variable screening. Multivariable Cox regression analyses were used to determine the independent risk factors of stroke recurrence.

Results

A total of 97 participants (59 ± 12 years, 63 men) were followed for a median of 30.9 months, and 21 participants experienced recurrent strokes. Multivariable Cox analysis identified co-existing intracranial high signal on T1-weighted fat-suppressed images (HST1) and extracranial carotid atherosclerosis (HR, 6.12; 95% CI, 2.52–14.82; p = 0.001) as an independent imaging predictor of stroke recurrence.

Conclusion

Co-existing intracranial HST1 and extracranial carotid atherosclerosis independently predicted LAA stroke recurrence. Combined head-and-neck HR-VWI is a promising technique for atherosclerosis imaging.

Clinical relevance statement

This prospective study using combined head-and-neck HR-VWI highlighted the necessity of both intracranial culprit plaque evaluation and multi-vascular bed assessment, adding value to the prediction of stroke recurrence.

Key Points

• This study highlighted the necessity of both intracranial culprit plaque evaluation and multi-vascular bed assessment, adding value to the prediction of stroke recurrence.

• This prospective study using combined head-and-neck HR-VWI found co-existing intracranial HST1 and extracranial carotid atherosclerosis to be independent predictors of stroke recurrence.

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Abbreviations

HR:

Hazard ratio

HR-VWI:

High-resolution vessel wall imaging

HST1:

High signal on T1-weighted fat-suppressed images

LAA:

Large-artery atherosclerosis

Lasso:

Least absolute shrinkage and selection operator

SI:

Signal intensity

TIA:

Transient ischemic attack

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Funding

This work was supported by the Natural Scientific Foundation of China (NSFC) (Grant No. 82171916 to S. Xia) and the Natural Science Foundation of Tianjin (Grant No. 20JCQNJC01250 to C. Cao). This work was also funded by the Tianjin Key Medical Discipline (Specialty) Construction Project. Chengcheng Zhu was supported by United States National Institute of Health (NIH) grants R01HL162743 and R00HL136883.

Author information

Author notes

  1. Gemuer Wu and Chengcheng Zhu contributed equally to this study as co-first authors.

Authors and Affiliations

  1. Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China

    Gemuer Wu, Lixiang Huang & Shuang Xia

  2. Department of Radiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, China

    Gemuer Wu

  3. Department of Radiology, University of Washington, 325 9Th Ave, Seattle, WA, 98104, USA

    Chengcheng Zhu & Mahmud Mossa-Basha

  4. The School of Medicine, Nankai University, 94 Weijin Road, Tianjin, 300071, China

    Huiying Wang

  5. Department of Radiology, The Second Affiliated Hospital of Wannan Medical College, 10 Kangfu Road, Jinghu District, Wuhu, 241000, China

    Dingwei Fu

  6. Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, China

    Xiudi Lu

  7. Department of Radiology, Tianjin Huanhu Hospital, Tianjin, 300350, China

    Chen Cao

  8. MR Collaboration, Siemens Healthineers Ltd., Beijing, China

    Xianchang Zhang & Jinxia Zhu

Authors
  1. Gemuer Wu
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  11. Shuang Xia
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Corresponding author

Correspondence to Shuang Xia.

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Guarantor

The scientific guarantor of this publication is Shuang Xia.

Conflict of interest

Authors Xianchang Zhang and Jinxia Zhu are employees of Siemens Healthineers. The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was provided by all participants or their authorized proxy.

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Institutional review board approval was obtained.

Methodology

• Prospective study

• Observational

• Performed at one institution

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Wu, G., Zhu, C., Wang, H. et al. Co-existing intracranial and extracranial carotid atherosclerosis predicts large-artery atherosclerosis stroke recurrence: a single-center prospective study utilizing combined head-and-neck vessel wall imaging. Eur Radiol 33, 6970–6980 (2023). https://doi.org/10.1007/s00330-023-09654-5

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  • DOI: https://doi.org/10.1007/s00330-023-09654-5

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