Clinical Relevance of Plaque Distribution for Basilar Artery Stenosis

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FIG 1.
A, The basilar artery is divided into 4 quadrants at the axial position based on high-resolution MR imaging. B, The basilar artery is divided into 2 segments referring to the AICA on the basis of DSA, the proximal and distal segments. The junctional segment is defined when the plaque involves both segments across the anterior-inferior cerebellar artery.
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FIG 2.
An adult patient presented with recurrent stroke for 1 month. A, Preoperative DSA revealed 79.3% stenosis at the distal segment of the basilar artery. The middle column shows cross-sectional T1-weighted basilar artery images at the MLN (B) and reference (REF) (E) sites. The VA and LA at the MLN (B, VA = 0.157 cm², LA = 0.014 cm²) and REF (E, VA = 0.237 cm², LA = 0.075 cm²) sites were manually traced for measuring after zooming in ×400. The plaque burden was calculated as 16.6% using [(WA_MLN-WA_REF) / VA _MLN] × 100%. D, A 2.5 × 8 mm Apollo balloon-mounted stent (MicroPort NeuroTech) was positioned at the stenotic segment. DWI (C) and ADC imaging (F) confirmed a new mixed type of infarction (white arrows) after the intervention.

Table 1:

Clinical and lesion characteristics

Variables	All Patients (n = 140)	Ischemic Events (n = 16)	Nonischemic Events (n = 124)	P Value
Sex, male	106 (75.7%)	12 (75.0%)	87 (70.2%)	.914
Age (mean) (yr)	61.9 (SD, 7.7)	62.5 (SD, 6.6)	61.8 (SD, 7.9)	.728
BMI (mean) (kg/m²)	26.2 (SD, 3.0)	25.8 (SD, 2.2)	26.3 (SD, 3.1)	.522
Qualifying event				.419
TIA	23 (16.4%)	1 (6.3%)	22 (17.7%)
Stroke	117 (83.6%)	15 (93.7%)	102 (82.3%)
Hypertension	117 (83.6%)	14 (87.5%)	103 (83.1%)	.927
Diabetes mellitus	58 (41.4%)	7 (43.8%)	51 (41.1%)	.841
Hyperlipidemia	36 (25.7%)	4 (25.0%)	32 (25.8%)	1.000
CAD	14 (10.0%)	2 (12.5%)	12 (9.7%)	1.000
Smoking history	58 (41.4%)	6 (37.5%)	52 (41.9%)	.735
Drinking history	38 (27.1%)	3 (18.8%)	35 (28.2%)	.615
Preoperative mRS				.218
<2	125 (89.3%)	16 (100%)	109 (87.9%)
≥2	15 (10.7%)	0	15 (12.1%)
Stenosis degree (mean) (%)	77.7 (SD, 9.3)	76.2 (SD, 14.2)	77.9 (SD, 9.2)	.826
Plaque length (mean) (mm)	5.9 (SD, 3.8)	4.9 (SD, 3.2)	5.9 (SD, 3.9)	.212
Plaque burden (mean) (%)	5.5 (SD, 23.6)	19.3 (SD, 18.3)	3.7 (SD, 23.6)	.047
Remodeling index (mean)	0.8 (SD, 0.4)	0.9 (SD, 0.4)	0.8 (SD, 0.4)	.430
Treatment type				.323
PA	26 (18.6%)	5 (31.3%)	21 (16.9%)
BMS	30 (21.4%)	2 (12.5%)	28 (22.6%)
SES	84 (60.0%)	9 (56.2%)	75 (60.5%)

Note:—BMI indicates body mass index; CAD, coronary artery disease; PA, primary angioplasty; BMS, balloon-mounted stent; SES, self-expansion stent.

Table 2:

Plaque distribution of the basilar artery

Plaque Distribution	All Patients (n = 140)	Ischemic Events (n = 16)	Nonischemic Events (n = 124)	P Value
Axial position
Ventral	18 (12.9%)	2 (12.5%)	16 (12.9%)	1.000
Lateral	31 (22.1%)	7 (43.8%)	24 (19.3%)	.049
Dorsal	48 (34.3%)	3 (18.7%)	45 (36.3%)	.262
≥2 quadrants	43 (30.7%)	4 (25.0%)	39 (31.5%)	.776
Coronal position
Proximal segment	49 (35.0%)	6 (37.5%)	43 (34.7%)	1.000
Distal segment	85 (60.7%)	7 (43.8%)	78 (62.9%)	.176
Junctional segment	6 (4.3%)	3 (18.8%)	3 (2.4%)	.020

Table 3:

Relationship between plaque distribution and ischemic events by multivariate analysis