Objective:

The objective of this study is to develop a prediction model for detecting culprit plaque and measuring plaque activity and the risk of stroke recurrence using plaque morphology and related inflammatory processes and initiating necessary intervention/conservative measures. 

Background:

ICAD affects 33–50% of Asians and is the leading cause of stroke globally. Contrast-enhanced vessel wall imaging acts as an equivalent for plaque activity, which correlates to ischemic episodes. This study aims to characterize vessel wall architecture and assess plaque activity in intracranial stenosis.

Design/Methods:

Cross-sectional, observational study, including 50 patients over a period of 6 months.

Results:

The median age of our population was 52, with hypertension (60%) and diabetes (50%) as primary comorbidities. 55% were addiction-free, and tobacco (30%) was the most prevalent addiction. Subcortical involvement was observed in the majority (60%) of patients, while 35% were associated with cortical, internal, and exterior watershed infarcts. The median mrASPECTS score was six. Patients exhibited a median of two plaques, with a median occlusion of 70%. The anterior circulation contributed to 90% of plaques, with the internal carotid artery (ICA) contributing to 75% and the middle cerebral artery (MCA) contributing to 50%. The median plaque length measured 6.5mm. Post-contrast enhancement was seen in 70% of plaques, while 16% showed signs of intraplaque hemorrhage.

Conclusions:

Our findings suggest that contrast-enhancing plaque indicates instability when imaged promptly after a stroke. The findings are consistent with extracranial atherosclerotic plaques, linking contrast enhancement with inflammation and instability. Based on plaque morphology, this model and other similar prospective models might predict culprit plaque, plaque activity, and stroke recurrence risk.