The Association Of Intracranial Large Artery Atherosclerosis With Cerebral Small Vessel Disease Imaging Markers: A High-resolution Magnetic Resonance Imaging Study

Objective: To evaluate the association of non-stenotic intracranial atherosclerotic plaque(IAP)with cerebral small vessel disease(CSVD)imaging markers in a CSVD population using 3.0 T high-resolution magnetic resonance imaging(HRMRI),which was validated in a cohort of embolic stroke of undetermined source(ESUS)population.Methods: We retrospectively recruited consecutive patients who were diagnosed with CSVD or ESUS from January 2015 to December 2019.All patients underwent intracranial HRMRI to assess the presence and vulnerability of IAP.Baseline and imaging data were collected and CSVD imaging markers were measured among all patients.Results: Among 153 patients with CSVD,there were 59 with IAP and 94 with non-IAP,including 36 with intracranial atherosclerotic complicated plaque(IACP).Among 227 ESUS patients,there were 155 with IAP and 72 with non-IAP,including 127 with IACP.In the CSVD population,we found that:(1)CSVD burden was associated with IAP(P=0.036)and IACP(P=0.008);(2)IAP were associated with white matter hyperintensity(P=0.039),and IACP were associated with lacunes(P =0.009)and enlarge perivascular space(P=0.022).The similar association of CSVD imaging markers with IAP or IACP was found in the ESUS population.Furthermore,the association of unilateral IAP and IACP with CSVD imaging markers of ipsilateral hemisphere was identified in the two cohorts.Interpretation: This is the first report that non-stenotic intracranial atherosclerotic plaque,especially complicated plaque,is closely associated with CSVD imaging markers,which provide further evidence for the association of large artery atherosclerosis with CSVD.