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Culprit intracranial plaque without substantial stenosis in acute ischemic stroke on vessel wall MRI: A systematic review

  • Author Footnotes
    1 These authors contribute equally to this work.
    Yuting Wang
    Correspondence
    Corresponding author. No. 32, Section 2, 1st Ring Road (West), Chengdu, 610072, China.
    Footnotes
    1 These authors contribute equally to this work.
    Affiliations
    Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China

    Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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  • Author Footnotes
    1 These authors contribute equally to this work.
    Xinke Liu
    Footnotes
    1 These authors contribute equally to this work.
    Affiliations
    Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA

    Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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  • Xiao Wu
    Affiliations
    Department of Radiology and Biomedical Imaging, Yale School of Medicine and Yale University, New Haven, CT, USA
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  • Andrew J. Degnan
    Affiliations
    Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Department of Radiology, Children's Hospital of Philadelphia, PA, USA
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  • Ajay Malhotra
    Affiliations
    Department of Radiology and Biomedical Imaging, Yale School of Medicine and Yale University, New Haven, CT, USA
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  • Chengcheng Zhu
    Correspondence
    Corresponding author. 4150 Clement Street, San Francisco, CA, 94112, USA.
    Affiliations
    Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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  • Author Footnotes
    1 These authors contribute equally to this work.

      Highlights

      • About half of acute ischemic strokes patients with non-stenotic intracranial MRA have identified plaques on vessel wall MRI.
      • About half of acute ischemic stroke patients with clinical intracranial atherosclerosis present <50% stenosis on MRA.
      • Intracranial high-risk plaque with zero or mild stenosis is associated with ischemic stroke and unfavorable outcome.
      • Vessel wall MRI can identify the high-risk plaque features and better risk stratify stroke patients.

      Abstract

      Background and aims

      Intracranial atherosclerotic plaque is associated with ischemic strokes without substantial stenosis, and needs better characterization. We aim to investigate the clinical significance of intracranial plaque without substantial stenosis by high resolution vessel wall MRI (vwMRI) through a systematic review of existing studies.

      Methods

      Studies investigating intracranial arterial atherosclerotic plaques without substantial stenosis in acute ischemic stroke patients using vwMRI were systematically identified by searching the PubMed and Medline database and article reference lists. Study characteristics were recorded, the methodological quality of eligible studies was assessed, relevant clinical data were extracted, and collective data was analyzed.

      Results

      Twenty-one studies were identified as eligible. 463 patients were included without stenosis of the intracranial arteries, and 651 patients were included with stenosis <50%. The prevalence of intracranial plaque revealed by vwMRI among acute/subacute ischemic stroke patients with non-stenotic Magnetic Resonance Angiography (MRA) was 50.6% (95% confidence interval (CI), 46.1%–55.1%). The prevalence of <50% MRA stenotic culprit plaque among acute/subacute ischemic stroke patients with a clinical diagnosis of intracranial atherosclerosis was 51.2% (95% CI, 38.4%–64.0%). Plaques features, including wall enhancement, positive remodeling, intraplaque hemorrhage, plaque location and eccentricity, were associated with acute stroke, progressive motor deficits and unfavorable overall functional outcomes.

      Conclusions

      Intracranial high-risk plaque with zero or mild degree of stenosis is more prevalent than previously acknowledged, and is associated with ischemic stroke and unfavorable outcome. VwMRI can identify the high-risk plaque features, which may act as a promising tool to better risk stratify these patients.

      Graphical abstract

      Keywords

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