Abstract
BackgroundElevated plasma homocysteine (Hcy) is an independent risk factor for ischemic stroke. This study aimed to evaluate the association between Hcy levels and intracranial plaque characteristics and to investigate their clinical relevance in ischemic stroke.MethodsNinety-four patients with intracranial atherosclerosis (ICAS) were enrolled. Plasma Hcy levels were measured. Intracranial plaque characteristics including plaque enhancement, stenosis ratio, T2 and T1 hyperintense components were assessed on high-resolution magnetic resonance imaging. Logistic regression model was constructed to analyze the association between high Hcy levels and plaque characteristics, and their synergistic effects to predict the likelihood for ischemic stroke, while adjusting for demographics and traditional atherosclerotic risk factors.ResultsElevated Hcy level was associated with strong plaque enhancement independently of age, sex, serum creatinine levels and other atherosclerotic risk factors ((P < 0.001, OR 6.00, 95% confidence interval [CI] 2.28–15.74). Both strong plaque enhancement (P = 0.026, OR 5.63, 95% CI 1.23–25.81) and high Hcy level (P = 0.018, OR 6.20, 95% CI 1.36–28.26) were correlated with acute ischemic stroke. The combination of them strengthened the ability to stratify the likelihood for ischemic stroke, with an improved area under the receiver operating characteristic curve (AUC) of 0.871, significantly higher than that of strong plaque enhancement (0.755) and high Hcy level (0.715) alone (P < 0.05 for both).ConclusionsHigh Hcy level appears to have association with intracranial strong plaque enhancement. The combined assessment of plasma Hcy levels and plaque enhancement may improve ischemic stroke risk stratification.
Highlights
Elevated plasma homocysteine (Hcy) is an independent risk factor for ischemic stroke
We aimed to evaluate the association between Hcy levels and intracranial plaque characteristics assessed on high-resolution magnetic resonance imaging (HR-MRI) and investigated their clinical relevance in ischemic stroke events
The detailed inclusion criteria were as follows: (1) plaque of middle cerebral artery (MCA) or basilar artery (BA) confirmed on HR-MRI; (2) absence of significant stenosis of extracranial carotid and vertebral artery (≥ 30%); (3) patients had one or more traditional atherosclerotic risk factors which included hypertension, vdiabetes mellitus, hypercholesterolemia and current cigarette smoking; and (4) the image quality of HR-MRI was adequate for evaluation
Summary
Elevated plasma homocysteine (Hcy) is an independent risk factor for ischemic stroke. This study aimed to evaluate the association between Hcy levels and intracranial plaque characteristics and to investigate their clinical relevance in ischemic stroke. Large artery atherosclerosis is a major cause of ischemic stroke and can be divided into intracranial atherosclerosis (ICAS) and extracranial atherosclerosis [2]. Elevated plasma homocysteine (Hcy) levels have been indicated as an independent risk factor for ischemic stroke [7, 8]. Studies have revealed that high Hcy levels are associated with advanced carotid plaque and greater incidence of acute ischemic stroke in patients with carotid artery plaques [7, 10,11,12,13]. The plaque burden of intracranial artery is greater in Asian population, little data are available regarding the relationship between Hcy levels and intracranial plaque stability
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