The Relationship Between The Magnetic Resonance Imaging Characteristics Of Carotid Atherosclerotic With Cerebral Small Vessel Diseases And The Risk Of Ischemic Stroke And Its Recurrence

Purpose There are three parts in this study.The first part was to assess the relationship between the magnetic resonance imaging(MRI)characteristics of carotid atherosclerotic and cerebral small vessel diseases(CSVD);The second part was to investigate the correlation between the MRI characteristics of carotid atherosclerosis with CSVD and acute cerebral infarct.The third part was to evaluate the association between the MRI characteristics of carotid atherosclerosis with CSVD and the recurrence of stroke.Materials and Methods Part 1: The carotid plaque characteristics of all patients,such as luminal stenosis,lipid-rich necrotic core(LRNC),calcification,thin/ruptured fibrous cap,intraplaque hemorrhage(IPH),irregular plaque surface and vulnerable plaque,were evaluated.The CSVD characteristics,including white matter hyperintensities(WMHs)and lacunes,were also analyzed,and the severity of WMHs was graded using the Fazekas score.Univariate and multivariate logistic regressions were used to analysis the relationship between the MRI characteristics of carotid plaque and CSVD,and the odds ratio(OR)and corresponding 95% confidence interval(CI)were calculated.Part 2: In addition to analyzing the MR images of the first part,the presence or absence of acute cerebral infarct on the brain MR images was also analyzed.Univariate and multivariate logistic regressions were used to evaluate the association between the MRI characteristics of single carotid plaque,CSVD and the co-existing carotid plaque and CSVD and acute cerebral infarct,and the odds ratio and corresponding 95% CI were calculated.Part 3: At baseline,the characteristics of carotid plaque and CSVD were evaluated.Then,the enrolled patients were followed-up for 1 year to record the time of the recurrence of stroke.Univariate and multivariate Cox regressions were used to calculate the hazard ratio(HR)and corresponding 95% CI of the MRI characteristics of the co-existing carotid plaque and CSVD in predicting the recurrence of stroke.Results Part 1: Of the 200 recruited patients,138(69.0%)were males,the mean age was 57.5 ± 10.7 years old.The prevalence of carotid calcification,LRNC,IPH,thin/ruptured fibrous cap,irregular plaque surface and vulnerable plaque was 37.5%(75/200),61.0(122/200),14.5%(29/200),34.5%(69/200),59.0%(118/200)and 67.0%(134/200),respectively.The prevalence of the severity of WMHs and lacunes was 44.0%(88/200)and 47.0%(94/200),respectively.Univariate logistic regression showed that the presence of LRNC(OR,2.26;95% CI,1.25-4.10;P = 0.007),thin/ruptured fibrous cap(OR,1.81;95% CI,1.01-3.27;P = 0.048),irregular plaque surface(OR,2.39;95% CI,1.32-4.30;P = 0.004)and vulnerable plaque(OR,3.25;95% CI,1.70-6.21;P <0.001)were significant associated with the severity of WMHs.After adjusting the confounding factors,irregular plaque surface(OR,2.37;95% CI,1.16-4.86;P = 0.019)and vulnerable plaque(OR,3.97;95% CI,1.74-9.03;P = 0.001)remained significantly associated with the severity of WMHs.Univariate logistic regression showed that the presence of thin/ruptured fibrous cap(OR,2.16;95% CI,1.19-3.90;P = 0.011),irregular plaque surface(OR,2.68;95% CI,1.49-4.81;P = 0.001)and vulnerable plaque(OR,2.84;95% CI,1.52-5.30;P = 0.001)were significantly associated with lacune.After adjusting confounding factors,irregular plaque surface(OR,2.24;95% CI,1.14-4.93;P = 0.020)and vulnerable plaque(OR,2.40;95% CI,1.15-5.04;P = 0.020)remained significantly associated with lacune.Part 2: Of the 200 patients,the prevalence of co-existing the severity of WMHs and calcification,LRNC,IPH,thin/ruptured fibrous cap,irregular plaque surface and vulnerable plaque was 19.0%(38/200),31.5%(63/200),7.5%(15/200),18.5%(37/200),31.0%(62/200)and 35.5%(71/200),respectively.Univariate logistic regression showed that the co-existing the severity of WMHs and calcification(OR,2.39;95% CI,1.03-5.54;P = 0.043),LRNC(OR,3.22;95% CI,1.57-6.57;P = 0.001),thin/ruptured fibrous cap(OR,3.43;95% CI,1.35-8.67;P = 0.009),irregular plaque surface(OR,8.31;95% CI,3.36-20.56;P <0.001)and vulnerable plaque(OR,6.38;95% CI,2.92-13.90;P <0.001)were significantly associated with acute cerebral infarct.After adjusting confounding factors,the co-existing the severity of WMHs and LRNC(OR,3.27;95% CI,1.31-8.17;P = 0.011),irregular plaque surface(OR,6.49;95% CI,2.30-18.28;P <0.001)and vulnerable plaque(OR,5.13;95% CI,2.01-13.06;P = 0.001)remained significantly associated with acute cerebral infarct.Univariate logistic regression showed that the co-existing lacune and LRNC(OR,3.32;95% CI,1.63-6.78;P = 0.001),thin/ruptured fibrous cap(OR,2.71;95% CI,1.17-6.24;P = 0.019),irregular plaque surface(OR,4.83;95% CI,2.27-10.26;P <0.001)and vulnerable plaque(OR,4.55;95% CI,2.24-9.26;P <0.001)were significantly associated with acute cerebral infarct.After adjusting confounding factors,the co-existing lacune and LRNC(OR,2.82;95% CI,1.16-6.88;P = 0.022),irregular plaque surface(OR,3.66;95% CI,1.52-8.81;P =0.004)and vulnerable plaque(OR,3.24;95% CI,1.40-7.49;P = 0.006)remained significantly associated with acute cerebral infarct.Part 3: Of the 64 recruited patients,44(68.8%)were males,the mean age was 58.3 ± 11.4 years old.During the median follow-up time of 12.1 months,11(17.2) patients had the recurrence of stroke.The prevalence of co-existing the severity of WMHs and calcification,LRNC,IPH,thin/ruptured fibrous cap,irregular plaque surface and vulnerable plaque was 23.4%(15/64),39.1%(25/64),12.5%(8/64),29.7%(19/64),42.2%(27/64)and 46.9%(30/64),respectively.The prevalence of coexisting lacune and calcification,LRNC,IPH,thin/ruptured fibrous cap,irregular plaque surface and vulnerable plaque was 15.6%(10/64),34.4%(22/64),10.9%(7/64),25.0%(16/64),39.1%(25/64)and 40.6%(26/64),respectively.Univariate Cox regression showed that the co-existing lacune and LRNC(HR,7.44;95% CI,1.96-28.29;P = 0.003),thin/ruptured fibrous cap(HR,3.78;95% CI,1.15-12.46;P = 0.029)and vulnerable plaque(HR,4.00;95% CI,1.05-15.24;P = 0.042)were significantly associated with the recurrence of stroke.After adjusting confounding factors,there associations remained significantly(co-existing LRNC and lacune: HR=8.16,95% CI 2.13-31.25;P = 0.002;co-existing thin/ruptured fibrous cap and lacune: HR=5.14,95% CI 1.45-18.26;P = 0.011 and co-existing vulnerable plaque and lacune: HR=7.01,95% CI 1.08-45.71,P = 0.042).Conclusions Carotid atherosclerosis characteristics,particularly irregular plaque surface and vulnerable plaque,were independent risk factors for cerebral small vessel diseases.The co-existing carotid atherosclerosis and cerebral small vessel diseases,particularly co-existing the severity of white matter hyperintensities and irregular plaque surface and co-existing lacune and irregular plaque surface,were independent risk factors for acute cerebral infarct.The co-existing carotid atherosclerosis and cerebral small vessel diseases,particularly co-existing lipid-rich necrotic core and lacune,are independent predictors for the recurrence of stroke.