Characteristics of Atherosclerotic Plaques and Stroke Mechanism in Patients with Border-Zone Infarcts: A High-resolution Magnetic Resonance Imaging Study

Qin Huang; Lei Liu; Shuo Zhang; Yao Yu; Yantong Yang; Xianjin Zhu; Zunjing Liu

doi:10.1016/j.acra.2024.03.039

Characteristics of Atherosclerotic Plaques and Stroke Mechanism in Patients with Border-Zone Infarcts: A High-resolution Magnetic Resonance Imaging Study

Acad Radiol. 2024 Apr 15:S1076-6332(24)00203-4. doi: 10.1016/j.acra.2024.03.039. Online ahead of print.

Authors

Qin Huang¹, Lei Liu², Shuo Zhang¹, Yao Yu¹, Yantong Yang¹, Xianjin Zhu³, Zunjing Liu⁴

Affiliations

¹ Department of Neurology, Peking University People's Hospital, 11 Xizhimen South Street, Xicheng District, Beijing, China.
² Department of Neurology, China-Japan Friendship Hospital, Beijing, China.
³ Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China; Department of Radiology, China-Japan Friendship Hospital, Beijing, China.
⁴ Department of Neurology, Peking University People's Hospital, 11 Xizhimen South Street, Xicheng District, Beijing, China. Electronic address: liuzunjing@bjmu.edu.cn.

PMID: 38627130
DOI: 10.1016/j.acra.2024.03.039

Abstract

Background: Relatively little is known about the plaque characteristics of border-zone infarcts and how they differ between cortical border-zone (CBZ) and internal border-zone (IBZ) infarcts.

Methods: We conducted a retrospective observational cohort study of patients with intracranial atherosclerotic disease who underwent high-resolution magnetic resonance imaging (HR-MRI) examination. Individuals with border-zone infarcts in the middle cerebral artery (MCA) territory, detected by diffusion-weighted imaging, were enrolled. Plaque morphological and compositional parameters of both IBZ and CBZ groups were compared. Independent predictors were identified using a binary logistic regression model, and the sensitivity and specificity of the model were assessed using a receiver operating characteristic curve. Kaplan-Meier survival analysis further explored differences in stroke recurrence between BZ patients with mono or dual antiplatelet therapy.

Results: We reviewed 101 symptomatic patients with border-zone infarcts (BZ) within the MCA territory in the study. Out of the patients meeting the imaging eligibility criteria, we detected 34 cases with isolated IBZ, 23 cases with isolated CBZ, and six cases with both IBZ and CBZ infarcts. Those with IBZ infarcts had a higher plaque burden than those without (p < 0.001), and those with CBZ infarcts exhibited a complicated plaque less frequently than those without (37.9% vs 67.6%, p = 0.018). In those with isolated IBZ or CBZ infarcts, plaque burden was independently associated with isolated IBZ infarcts (odd ratio=1.08; 95% CI, 1.02-1.15; p = 0.023). During the median follow-up period of 37 (27, 50) months, 13.8% of patients receiving early dual antiplatelet treatment and 30.4% of those on single antiplatelet therapy experienced stroke recurrence (p = 0.182).

Conclusion: Intracranial atherosclerotic plaque morphology and composition differ between patients with IBZ and those with CBZ infarcts. Higher plaque burden is more associated with IBZ infarcts.

Keywords: Border-zone infarcts; High-resolution magnetic resonance imaging; Intracranial atherosclerotic disease; Ischemic stroke; Plaque characteristics.