PLAQUE MORPHOLOGY PREDICTS LESION PROGRESSION AND STROKE RELAPSE IN MEDICALLY TREATED SYMPTOMATIC INTRACRANIAL ATHEROSCLEROTIC DISEASE (ID 823)

Presentation Topic
AS20 LARGE ARTERY ATHEROSCLEROSIS - INCLUDING INTRACRANIAL STENOSIS
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Abstract

Background And Aims

Patients with symptomatic intracranial atherosclerotic disease (ICAD) are at risk of stroke recurrence despite stringent medical therapy. Identifying plaque features governing ICAD evolution may help secondary stroke prevention.

Methods

In a prospective, multicenter referral, longitudinal study, we recruited adult patients with acute ischemic stroke or transient ischemic attack (TIA) attributed to high-grade ICAD (60-99% stenosis) confirmed by 3-dimensional rotational angiography (3DRA). All patients received guideline-recommended medical treatment and had a 2nd 3DRA at 1 year. We assessed ICAD plaque morphological features in paired 3DRAs, and explored for plaque features associated with the primary outcome, symptomatic ICAD progression within 1 year, defined as plaque morphology progression and/or recurrent relevant ischemic stroke/TIA.

Results

Among 78 patients (median age 61 years; 71.8% males) with symptomatic ICAD (median stenosis 78%), 25 (32.1%), 39 (50.0%) and 14 (17.9%) respectively had smooth, irregular and ulcerative plaques. Twenty-six (33.3%) patients had the primary outcome: recurrent relevant ischemic stroke/TIA in 17 (21.8%) and plaque morphology progression in 9 (11.5%). Thicker plaques (adjusted OR=6.89; 95% CI 1.69-28.12; p=0.007) with a smaller upstream plaque shoulder angulation (0.97; 0.95-1.00; p=0.061) and the maximum stenosis locating at the distal end of the lesion (7.41; 0.75-73.19; p=0.087) at baseline were at an increased risk of the primary outcome in multivariate logistic regression.

Conclusions

Under modern medical treatment, a majority of symptomatic ICAD lesions may stay quiescent or regress over 1 year after an index stroke, while plaque morphological features may govern the plaque evolution pattern and subsequent stroke risks.

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