Quantitative morphological and histogram characteristics associated with recurrent ischemic stroke after intensive medical therapy: a perspective 6-month follow-up study based on head&neck high-resolution vessel wall magnetic resonance imaging

Abstract

Abstract Intensive medical management has been recommended to 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 is unclear. The patients of acute ischemic stroke due to ICAS from two centers were prospectively analyzed, who underwent the 3D head&neck high-resolution 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. 222 patients (age, 59.5 ± 12.1; males, 153) were finally included, and 38 have 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 (0.859 vs 0.789; P = 0.01). The plaque characteristics based on hr-VW-MRI may provide complementary values over traditional clinical features in predicting ischemic recurrence for ICAS.