Article Figures & Data
Figures
- FIG 1.
Flow chart of the study population and patient grouping.
- FIG 2.
Intracranial plaque distribution and frequency. The schematic figure (A) shows analyzed artery segments with the frequency of intracranial plaques. The segments are shown in light gray: intracranial ICAs (cavernous/C3 and supraclinoid/C4 segments), A1 and A2 segments, M1 and M2 segments, P1 and P2 segments, basilar artery (BA), and intracranial vertebral arteries (V4). The frequency of plaques in the cohort (n = 175) is illustrated through plaques. A large dark-gray plaque indicates a higher frequency of plaques within the specific segment. The detailed results are listed in the Online Supplemental Data. The HR-VWI shows a patient with 5 intracranial plaques. Precontrast images indicate 2 left M1 plaques (B, arrows), 1 left ICA plaque (B, hollow arrow), 1 right M1 plaque (D, arrow), and 1 right ICA plaque (D, hollow arrow). Postcontrast HR-VWI (C and E) shows that the plaques are enhanced in different degrees. The last 2 columns show the cross-sectional views of each plaque. L indicates left; R, right.
- FIG 3.
Representative patients of recurrent- and first-time stroke groups. Upper row, A 64-year-old female patient with right-limb weakness and inarticulateness for 5 days. MR imaging was performed 9 days after symptom onset. DWI (A) shows a left basal ganglia infarction, FLAIR (B) shows a remote infarction on the left centrum semiovale, and HR-VWI (C and D) indicates M1 culprit plaque (arrow) (39.4 mm3), and other plaques detected in the left MCA, internal carotid artery, and left posterior cerebral artery (hollow arrows). The total plaque number is 5. Lower row, A 63-year-old male patient who presented with sudden abasia and inarticulateness for 2 hours. MR imaging was performed 5 days after the symptom onset. DWI (E) shows left insular and temporal lobe infarction, HR-VWI (F) shows a culprit plaque in the left M1 segment (arrow) (18.6 mm3), and no other plaques (G and H) are detected in other intracranial arteries. The total plaque number is 1.
Tables
Variables All Patients (n = 175) First-Time Stroke Group (n = 100) Recurrent-Stroke Group (n = 75) P Valuea Age (mean) (yr) 59 (SD, 12) 57 (SD, 13) 61 (SD, 10) .13 Sex (male) (%) 115 (65.7) 68 (68.0) 47 (62.7) .46 Hypertension (No.) (%) 145 (82.9) 85 (85.0) 60 (80.0) .39 Diabetes mellitus (No.) (%) 74 (42.3) 38 (38.0) 36 (48.0) .19 Coronary heart disease (No.) (%) 35 (20.0) 23 (23.0) 12 (16.0) .25 Hyperlipidemia (No.) (%) 68 (38.9) 37 (37.0) 31 (41.3) .56 Systolic blood pressure (median) (IQR) (mm Hg) 150 (135–163) 146 (131–162) 153 (140–167) .13 Diastolic blood pressure (median) (IQR) (mm Hg) 87 (79–95) 87 (78–96) 87 (80–93) .98 Smoking (No.) (%) 83 (47.4) 49 (49.0) 34 (45.3) .63 Preadmission statin use (No.) (%)b 24 (13.7) 7 (7.0) 17 (22.7) .003 Onset-to-HR-VWI time (median) (IQR) (days) 10 (6–15) 11 (6–15) 10 (6–15) .93 Admission NIHSS score (median) (IQR) 2 (1–4) 2 (1–4) 3 (2–4) .11 White blood cell count (median) (IQR) (109/L) 7.2 (6.2–8.3) 7.4 (6.4–8.5) 7.1 (5.9–8.3) .19 Fasting blood glucose level (median) (IQR) (mmol/L) 5.8 (4.9–7.9) 5.8 (4.8–7.8) 5.8(5.1–8.0) .65 Total cholesterol level (mean) (mmol/L) 4.6 (SD, 1.1) 4.6 (SD, 1.0) 4.7 (SD, 1.2) .68 High-density lipoprotein level (median) (IQR) (mmol/L) 1.0 (0.9–1.2) 1.0 (0.9–1.2) 1.0 (0.9–1.2) .99 Low-density lipoprotein level (mean) (mmol/L) 3.1 (SD, 0.9) 3.1 (SD, 0.8) 3.0 (SD, 1.0) .37 Triglyceride level (median) (IQR) (mmol/L) 1.5 (1.2–2.0) 1.4 (1.1–2.0) 1.5 (1.2–2.0) .97 Stroke territories .96 Anterior circulation (No.) (%) 124 (70.9) 71 (71.0) 53 (70.7) Posterior circulation (No.) (%) 51 (29.1) 29 (29.0) 22 (29.3) Variables All Patients (n = 175) First-Time Stroke Group (n = 100) Recurrent-Stroke Group (n = 75) P Valuea Culprit plaque features on high-resolution vessel wall imaging Plaque area (median) (IQR) (mm2) 5.8 (3.7–7.5) 5.8 (3.5–7.4) 5.7 (4.2–7.8) .40 Plaque burden (median) (IQR) (%) 74.6 (55.9–87.9) 72.9 (54.9–85.6) 75.0 (60.6–89.9) .26 Plaque volume (median) (IQR) (mm3) 45.8 (31.3–67.7) 41.3 (27.6–60.2) 50.7 (34.3–74.6) .006 Arterial remodeling ratio (median) (IQR) 1.2 (1.0–1.5) 1.2 (1.0–1.5) 1.2 (1.0–1.5) .83 Positive remodeling (No.) (%) 122 (69.7) 70 (70.0) 52 (69.3) .92 Eccentric index (median) (IQR) 0.6 (0.4–0.7) 0.6 (0.4–0.7) 0.6 (0.4–0.7) .54 Eccentricity (No.) (%) 110 (62.9) 61 (61.0) 49 (65.3) .56 Intraplaque hemorrhage (No.) (%) 59 (33.7) 35 (35.0) 24 (32.0) .68 Degree of stenosis (median) (IQR) (%) 44.7 (31.3–63.6) 44.1 (30.7–59.8) 46.8 (32.6–71.8) .23 Enhancement ratio (median) (IQR) 1.6 (1.3–2.0) 1.6 (1.2–2.0) 1.6 (1.3–1.9) .89 Plaque No. of each patient Total plaque No. (median) (IQR) 4 (3–6) 4 (2–5) 5 (4–7) <.001 Enhanced plaque No. (median) (IQR) 2 (1–4) 2 (1–3) 3 (2–4) .003 Hypoperfusion volume (median) (IQR) (mL) 0 (0–17.4) 0 (0–24.5) 0 (0–15.4) .67 Hypoperfusion intensity ratio (median) (IQR) 0 (0–0) 0 (0–0) 0 (0–0) .94 Hypoperfusion (No.) (%) 55 (31.4) 29 (29.0) 26 (34.7) .42 ↵a Comparison between recurrent-stroke group and first-time stroke groups.
- Table 3:
Univariable and multivariable analysis to identify parameters associated with patients with recurrent stroke compared with patients with the first-time stroke
Variables Univariable Regression Analysis Multivariable Regression Analysis OR 95% CI P Value OR 95% CI P Value Culprit plaque volumea 1.17 1.04–1.31 .008 1.16 1.03–1.30 .015 Total plaque No. 1.32 1.14–1.53 <.001 1.31 1.13–1.52 <.001 Enhanced plaque No. 1.32 1.09–1.60 .005 NA NA .89 Note:—NA indicates not available.
↵a OR based on every cubic millimeter increase.
