Intraplaque Enhancement Is Associated With Artery-to-Artery Embolism in Symptomatic Vertebrobasilar Atherosclerotic Diseases

Abstract

Objective: There are limited data regarding the characteristics of intracranial plaques according to stroke mechanism in the posterior circulation. This study aims to compare whether the plaque characteristics and baseline features are different in patients with artery-to-artery (A-to-A) embolism and those with parent artery disease in the intracranial vertebrobasilar atherosclerotic disease. Methods: From September 2014 to January 2017, patients with recent posterior circulation stroke due to intracranial vertebrobasilar atherosclerotic disease were retrospectively analyzed. Patients with the following eligibility criteria were included: (1) age ≥18 years old, (2) ischemic stroke in the vertebrobasilar territory, (3) 70-99% stenosis of the intracranial vertebral artery or basilar artery, and (4) two or more atherosclerotic risk factors. Patients with concomitant ipsilateral or bilateral extracranial vertebral artery >50% stenosis, cardio-embolism, or non-atherosclerotic stenosis were excluded. The plaque characteristics, including intraplaque compositions (intraplaque hemorrhage and intraplaque calcification), intraplaque enhancement, and remodeling index, were evaluated by using 3T high-resolution magnetic resonance imaging (HRMRI). The baseline features including vascular risk factors and the involved artery were collected. Patients were divided into A-to-A embolism and parent artery disease groups based on the diffusion-weighted images, T2-weighted images, or computed tomography. The plaque characteristics and baseline features were compared between the two groups. Results: Among consecutive 298 patients, 51 patients were included. Twenty-nine patients had A-to-A embolism and 22 patients had parent artery disease. Compared with parent artery disease, the occurrence rates of intraplaque enhancement and intracranial vertebral involvement were higher in the A-to-A embolism group (79.3 vs. 36.4%; p = 0.002 and 62.1 vs. 18.2%; p = 0.002, respectively). Multivariable logistic regression analysis showed that intraplaque enhancement and intracranial vertebral artery plaques were also associated with A-to-A embolism (adjusted OR, 7.31; 95% CI 1.58-33.77; p = 0.011 and adjusted OR, 9.42; 95% CI 1.91-46.50; p = 0.006, respectively). Conclusion: Intraplaque enhancement and intracranial vertebral artery plaques seem to be more closely associated with A-to-A embolism than parent artery disease in patients with symptomatic intracranial vertebrobasilar disease. Clinical Trial Registration:http://www.clinicaltrials.gov, identifier: NCT02705599.

Keywords: atherosclerosis; intracranial stenosis; ischemic stroke; magnetic resonance imaging; vertebrobasilar disease.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Hou, Li, Lyu, Xu, Liu, He, Jing, Wang, Wang, Lou, Miao and Ma.

Figures

Figure 1

Flow chart of the study.

Figure 2

An 80-year-old man presented with dizziness for 15 days. The diffusion-weighted imaging (DWI) showed infarcts of bilateral occipital lobes and left cerebellum (A). The digital subtraction angiography (DSA) showed severe stenosis at the V4 segment of the right vertebral artery (arrow) (B). The high-resolution magnetic resonance imaging (HRMRI) demonstrated a diffuse distributive plaque (arrow) (C) with an eccentric enhancement (arrowheads) on T1-weighted image after gadolinium–DTPA injection (D).

Figure 3

A 68-year-old man presented with dysarthria for 20 days. The DWI showed an infarct located at the right pons (A). The DSA showed severe stenosis in the middle segment of the basilar artery (arrow) (B). The HRMRI demonstrated a diffuse distributive plaque (arrow) (C). There was no plaque enhancement on T1-weighted image after gadolinium–DTPA injection (D).