Study Of Parent Artery Plaque In Patients With Acute Single Subcortical Infarction

Background and purpose:Histopathology studies have suggested that single subcortical infarction(SSI)may be caused by obstruction at the arterial origin of penetrating vessels due to parent artery plaque(PAP).In vivo confirmation,however,remains lacking.We aimed to investigate the prevalence and clinical relevance of PAP in acute SSI using three-dimensional T1-weighted high-resolution magnetic resonance imaging(HR-MRI).Methods:We included patients with acute first-ever SSI in the middle cerebral artery(MCA)and basilar artery(BA)territory without significant stenosis(?50%)of relevant large arteries or potential cardiac embolisms within 72 hours of symptom onset from a prospective,multicenter,cohort study named Stroke Imaging Package Study(SIPS).We evaluated PAPs on HR-MRI and other imaging markers(infarct lesions and cerebral small vessel disease[CSVD]burden)on conventional brain MRI sequences.Baseline characteristics including demographic data,traditional vascular risk factors,National Institution of Health Stroke Scale(NIHSS)score at admission and related treatments were collected.Stroke outcome measurements included neurological deterioration during hospitalization,a poor 90-day functional outcome(modified Rankin Scale score>2)and stroke recurrence.Results:The data of 303 patients with SSI were analyzed(mean age[SD],59.4[10.6]years;72%were male).Of the 201 patients with SSI in the MCA territory and 102 patients in the BA territory,64(31.8%,64/201)had MCA plaques and 66(64.7%,66/102)had BA plaques.Most patients had their plaques located at the artery wall where the perforators usually arose(MCA plaques:superior and/or dorsal wall[71.9%];BA plaques:dorsal wall and/or the wall ipsilateral to the infarct[90.9%]).The infarct volume between patients with and without PAP was similar,but patients with PAP had different infarct patterns compared with those without(MCA plaque:infarct involving the posterior limb of the internal capsule[42.2%vs.25.5%,p=0.02];BA plaque:infarct extending to the ventral surface of the pons[74.2%vs.52.8%,p=0.03]).In addition,patients with PAP more likely had severe CSVD burden.The MCA plaque was independently associated with cerebral microbleeds,higher grade of enlarged perivascular spaces in basal ganglia,and higher total SVD score.The BA plaque was independently associated with moderate to severe enlarged perivascular spaces in basal ganglia.The presence of an MCA plaque significantly predicted a poor 90-day functional outcome(adjusted odds ratio[aOR],3.839,95%CI 1.252-11.766),while the presence of a BA plaque did not(aOR,1.998;95%CI 0.449-8.895).Neither plaque was associated with neurological deterioration during hospitalization or stroke recurrence.Conclusions:More than one third of SSIs were related to PAP.Patients with PAP were more likely had coexistence of small vasculopathy.The MCA plaque is a robust predictor of poor 90-day functional outcome in SSI.Our results highlight the potential role of HR-MRI to evaluate PAP for subtyping SSI and guiding treatments.