Association Between Intracranial Atherosclerotic Plaque Stability And Ischemic Stroke

ObjectiveTo evaluate the stability of the atherosclerotic plaques of intracranial responsible arterials in patients with acute ischemic stroke using High Resolution Magnetic Resonance Imaging(HRMRI).To detect the risk factors of plaque stability.To assess the relationship between plaque stability and clinical prognoses of acute ischemic stroke patients.MethodsFrom January 2015 to November 2018,a total of 317 patients with acute ischemic stroke hospitalized into the stroke center of Northern Jiangsu People’s Hospital were enrolled continuously.Clinical baseline data of these patients were collected(including age,sex,hypertension,diabetes,atrial fibrillation,smoking history,drinking history,fasting blood glucose,HbA1 c,blood lipid,blood routine,diastolic blood pressure,systolic blood pressure,etc.),and general examinations(including electrocardiogram,dynamic electrocardiogram,carotid duplex ultrasound,transcranial doppler or CTA of head and neck)and HRMRI were performed.The vessel wall and the stability of atherosclerotic plaques of the intracranial responsible arterials were analyzed by HRMRI.The acute cerebral infarction patients were divided into two groups according to the stability of atherosclerotic plaques,and the risk factors of the patients in different groups were analyzed.National Institutes of Health Stroke Scale(NIHSS)scores of these patients were calculated at admission,3 days and 7days after onset and modified Rankin scores(mRS)were performed 3 months after onset so as to evaluate the clinical prognosis of patients in the two groups.ResultsA total of 270 patients with intracranial atherosclerotic got acute ischemic stroke:242 of them with acute cerebral infarction,including 138 with unstable plaques,82 with stable plaques and 22 only with thickening vessel wall in responsible arterials;28with transient ischemic attack(TIA),including 9 with unstable plaques,13 with stable plaques and 6 with thickening vessel wall in responsible arterials.The patients with acute cerebral infarction were divided into one group with unstable plaques(138 cases)and another with stable plaques(82 cases).In univariate analysis,fasting blood sugar(P=0.024),HbA1c(P=0.015),total cholesterol(P=0.045)and low density lipoprotein(P=0.023)levels were higher in the group with unstable plaques,and more patients with unstable plaques got hypertension(P=0.016)and extracranial atherosclerosis(P=0.019).Multivariate regression analysis showed that HbA1c(P=0.034)and total cholesterol(P=0.049)were independent risk factors of unstability plaques.There was no significant difference between these two groups in their NIHSS scores at admission,3 days and 7days after onset and mRS scores at 3 months after onset.ConclusionHRMRI can be used to evaluate intracranial atherosclerotic plaques and their stability.Our study shows that HbA1 c and total cholesterol might be independently related to the stability of intracranial atherosclerotic plaques.There was no significant correlation between plaque stability and clinical prognoses of the patients.