Abstract
BackgroundIt is still unknown that whether co-existing intracranial stenosis and extracranial carotid vulnerable plaques have higher predictive value for subsequent vascular events. This study aimed to determine the relationship between co-existing extracranial carotid vulnerable plaques and intracranial stenosis and subsequent vascular events utilizing cardiovascular magnetic resonance (CMR) vessel wall imaging.MethodsPatients who had recent cerebrovascular symptoms in anterior circulation (< 2 weeks) were consecutively enrolled and underwent multi-contrast CMR vessel wall imaging for extracranial carotid arteries and 3D time-of flight CMR angiography for intracranial arteries at baseline. After baseline examination, all patients were followed-up for at least 1 year to determined recurrence of vascular events. The co-existing cerebrovascular atherosclerosis was defined as presence of both intracranial artery stenosis and at least one the following measures of extracranial artery atherosclerosis: plaque, calcification, lipid-rich necrotic core (LRNC), or intraplaque hemorrhage. Univariate and multivariate Cox regressions were used to calculate the hazard ratio (HR) and corresponding 95% confidence interval (CI) of co-existing plaques in predicting subsequent vascular events.ResultsIn total, 150 patients (mean age: 61.8 ± 11.9 years; 109 males) were recruited. During the median follow-up time of 12.1 months, 41 (27.3%) patients experienced vascular events. Co-existing intracranial artery stenosis and extracranial carotid plaque (HR, 3.57; 95% CI, 1.63–7.82; P = 0.001) and co-existing intracranial artery stenosis and extracranial carotid LRNC (HR, 4.47; 95% CI, 2.15–9.27; P < 0.001) were significantly associated with subsequent vascular events, respectively. After adjusted for confounding factors and carotid stenosis, these associations remained statistically significant (HR, 5.12; 95% CI, 1.36–19.24; P = 0.016 and HR, 8.12; 95% CI, 2.41–27.31; P = 0.001, respectively).ConclusionsThe co-existing cerebrovascular atherosclerotic diseases, particularly co-existing carotid lipid-rich necrotic core and intracranial stenosis, are independent predictors for subsequent vascular events.
Highlights
It has been shown that vulnerable atherosclerotic plaque is the major cause of ischemic stroke or acute coronary syndrome [1,2,3]
After adjusted for baseline confounding factors including age, sex, body mass index (BMI), history of stroke, diabetes, hypertension, hyperlipidemia, coronary heart disease, smoking, National Institutes of Health Stroke Scale (NIHSS), carotid stenosis and treatment procedures including antihypertension, lipidlowering, anticoagulation and antiplatelet during followup, these associations remained statistically significant
This study investigated the relationship between co-existing intracranial stenosis and extracranial vulnerable plaques and subsequent vascular events utilizing cardiovascular magnetic resonance (CMR) vessel wall imaging
Summary
It has been shown that vulnerable atherosclerotic plaque is the major cause of ischemic stroke or acute coronary syndrome [1,2,3]. Previous studies demonstrated that co-existing intracranial and extracranial atherosclerotic plaques had stronger predictive value for future vascular events compared with atherosclerosis in single vascular bed [6, 7]. It is still unknown that whether coexisting intracranial stenosis and extracranial carotid vulnerable plaques have higher predictive value for subsequent vascular events. We hypothesized that co-existing carotid vulnerable plaque and intracranial stenosis may have stronger predictive value than each measurement alone for subsequent vascular events. This study aimed to determine the relationship between co-existing extracranial carotid vulnerable plaques and intracranial stenosis and subsequent vascular events utilizing cardiovascular magnetic resonance (CMR) vessel wall imaging
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