Application Of High-resolution Vascular Wall Imaging In Classification Of CISS In Ischemic Stroke And Prediction Of Early Neurological Deterioration

Objective: 1.In this study,high-resolution vascular wall imaging(HR-VWI)was used to obtain the pathological characteristics of intracranial arteries,the location and vulnerability of atherosclerotic plaques,and other information,so as to evaluate its application value in the classification of Chinese ischemic stroke subclassification(CISS)in ischemic stroke by comparing with conventional magnetic resonance imaging sequences.2.Quantitative analysis of intracranial atherosclerotic plaques was performed by HR-VWI,combined with general clinical data and laboratory examination,to analyze the influential factors of Early Neurological Deterioration(END)in the type of Large Artery Atherosclerosis(LAA)acute ischemic stroke,and to explore the predictive value of each factor for early neurological deterioration.Materials and Methods: In this prospective study,we continuously enrolled the patients who were hospitalized in the Department of Neurology in the first affiliated hospital of Dalian Medical University from November 2021 to November 2022 and diagnosed with acute ischemic stroke.All patients underwent high-resolution magnetic resonance imaging within 7 days of admission.Combined with general clinical date,laboratory and imaging examinations,we get the preliminary CISS classification of patients,and compared its difference with the CISS classification that after reading the HR-VWI sequence.All enrolled patients were evaluated by National Institutes of Health Stroke Scale(NIHSS)for 7 consecutive days after admission by 2 physicians with more than 10 years of clinical experience in cerebrovascular disease.END was defined asexacerbation of neurological impairment symptoms within 7 days of admission,and NIHSS score increased by ≥2 points compared with admission.We collected the general factors(gender,age,hypertension,diabetes,coronary heart disease,previous stroke history,smoking,alcohol consumption,NIHSS score on admission,m RS score on admission),laboratory tests(white blood cell count,neutrophil to lymphocyte ratio,blood glucose,blood lipid,uric acid,homocysteine,et al),high-resolution magnetic resonance imaging data(infarct volume,stenosis rate,plaque location,plaque length,plaque area,plaque load,remodeling pattern,etc.)of patients in the type of LAA acute ischemic stroke,explore its relationship to END.Then draw the ROC curve to evaluate the predictive value of each indicator to END.Results:1.A total of 118 patients with acute ischemic stroke who met the inclusion and exclusion criteria were included in this study,compared the preliminary CISS classification was performed in 118 patients and the CISS classification after reading HR-VWI,87 patients(73.7%)have the same CISS classification and 31 patients(26.3%)have differences in CISS classification after reading HR-VWI sequences.The proportion of LAA group was significantly increased(50.1% VS 76.3%),while that of Penetrating Arterial Disease(PAD)group was significantly reduced(44.1% VS 19.5%).We apply the Chi-squared Test to compare the CISS before and after the HR-VWI examination: χ2= 169.808,P < 0.001,the difference is statistically significant.After multiple comparison we found PAD with LAA group differences are statistically significant,P < 0.05.2.The study observed that END occurred in 23 of the 90 stroke patients classified as LAA according to the HR-VWI examination,accounting for 25.6%.3.Univariate analysis shows that: Hypertension,admission NIHSS score,admission m RS Score,ALT level,the level of sd-LDL,plaque area,plaque load,remodeling index and remodeling pattern were all correlated with the occurrence of END(P < 0.05).Multivariate analysis demonstrated that NIHSS admission score(OR =3.604,95% CI: 1.111～11.688,P<0.05),sd-LDL level(OR = 18.648,95% CI: 1.992～ 174.584,P<0.05),plaque area(OR = 2.530,95% CI: 1.021～6.269,P<0.05)were independent risk factors for patients with LAA acute ischemic stroke END.Admission NIHSS score,sd-LDL level,plaque area predicted the patients with LAA acute ischemic stroke END AUC were 0.799(95% CI: 0.702 ～ 0.876,P<0.001),0.711(95%CI: 0.606～0.803,P<0.05)and 0.825(95%CI: 0.731～0.897,P<0.001),The sensitivity were 56.52%,60.87% and 78.26%,and the specificity were 86.57%,89.39% and 73.13%.Conclusions:1.After reading the HR-VWI sequence,the proportion of LAA group was significantly increased,while that of PAD group was significantly decreased.The detection rate of intracranial atherosclerosis was improved by HR-VWI,which has very important clinical application value for guiding accurate CISS classification.2.Admission NIHSS score,sd-LDL level,and plaque area are independent risk factors for the occurrence of END in patients with LAA ischemic stroke.Admission NIHSS score,sd-LDL level,and plaque area can be used to predict the risk of END in patients with LAA type acute ischemic stroke,and plaque area is the better predictor of END.