Plaque characteristics and hemodynamics contribute to neurological impairment in patients with ischemic stroke and transient ischemic attack

Objectives We aimed to investigate differential characteristics of plaque in the middle cerebral artery (MCA) and hemodynamics in patients with ischemic stroke and transient ischemic attack (TIA), and to develop a predictive model for the presence of ischemic stroke and neurological impairment. Methods Sixty-seven patients with acute ischemic events in MCA territory who underwent high-resolution vessel wall imaging between September 2016 and August 2018 were reviewed retrospectively. Patients were assigned to either the stroke group or TIA group, according to diffusion-weighted imaging and neurological examination. Plaque characteristics and anterograde score (AnS) were calculated.Tmax > 6.0-s volume was acquired by RApid Processing of perfusIon and Diffusion software. Multivariate logistic regression analysis and multiple linear regression analysis were performed to establish a predictive model for irreversible infarction occurrence and clinical severity. Results Forty-five patients were assigned to the stroke group, and 22 were assigned to the TIA group. Plaque length, intraplaque hemorrhage (IPH), enhancement, AnS, andTmax > 6.0-s volumes were significantly different between the two groups (p< 0.05). IPH and AnS were independent predictors for patients with stroke (p= 0.020 and 0.034, respectively).Tmax > 6.0-s volume, IPH, hypertension, and AnS were associated with high National Institutes of Health Stroke Scale (NIHSS) scores (allp< 0.05,R= 0.725, and adjustedR(2)= 0.494). Conclusions IPH and AnS are useful in predicting stroke occurrence.Tmax > 6.0-s volume, IPH, hypertension, and AnS are associated with neurological impairment of the patients.

Automated summary

The characteristics of plaque in the middle cerebral artery (MCA) and hemodynamics may help predict the occurrence of ischemic stroke and neurological impairment. Intraplaque hemorrhage (IPH) and anterograde score (AnS) are independent predictors for stroke occurrence. Tmax > 6.0-s volume, IPH, hypertension, and AnS are associated with neurological impairment in patients.