Abstract WMP19: Stroke Risk in the Territory of Symptomatic Intracranial Arteries

Introduction: Recent advances in vessel wall MRI (VWMRI) have allowed characterization of intracranial atherosclerotic disease (ICAD), and some imaging characteristics, such as plaque enhancement, are associated with downstream stroke. We tested whether these features were also associated with recurrent cerebral infarction in stroke patients. Methods: 79 stroke patients with clinically established ICAD underwent VWMRI . Plaque number and features (enhancement, stenosis, eccentricity) were recorded. The cerebral infarcts were determined using DWI, and their responsible lesions (culprit) were identified based on previous established criteria. Patients were followed-up by routine clinical visits. Clinically-apparent strokes were reported and cerebral infarcts were characterized by a brain MRI acquired soon after event. Associations of imaging features and new infarcts were analyzed with adjustment for vascular risk factors. Results: Of the 79 patients (mean age 56y., 62% male, 56% whites), 13 had new infarcts (median follow-up, 16 months [IQR, 9-22 months] ). Among these 13 patients, 19 new brain infarcts were identified, and 16 were in the same vascular territories corresponding to the culprit plaque at baseline. Culprit plaques and plaque enhancement were strongly associated in univariate models with new infarcts, and in adjusted models, culprit plaques remained significant (OR 3.67, 95% CI 1.20-11.23) but plaque enhancement did not (OR 1.72, 95% CI 0.97-3.13) (Table). Plaque enhancement was associated with culprit plaques (OR 3.06, 95% CI 1.66-5.63). Conclusions: Culprit lesions were strongly associated with recurrent cerebral infarction in stroke patients, indicating increased risk for stroke in symptomatic arterial territories, likely caused by recurrent plaque rupture. Although plaque enhancement was not associated with new infarcts, its strong association with culprit lesions highlights its potential importance in future studies.