The Study On Characteristics Of Parent Artery For Symptomatic Middle Cerebral Artery Stenosis Plaque Based On High-resolution Magnetic Resonance Imaging

Objective:In patients with symptomatic middle cerebral artery(MCA)atherosclerotic stenosis,identifying the underlying stroke mechanism may aid in secondary prevention.The objective of this study was to investigate the atherosclerotic plaque characteristics in patients with perforator artery infarction of MCA M1 segment carrier artery occlusion based on high resolution magnetic resonance imaging(HR-MRI).Methods:A total of 237 patients admitted to the Eastern Theater Command General Hospital and the First Affiliated Hospital of Sun Yat-sen University for acute ischemic stroke from January 1,2014 to January 21,2022,who were further confirmed by HR-MRI with traditional imaging evidence of MCA stenosis and clear high signal in the responsible lesion area on diffusion weighted imaging(DWI),were recruited.According to the diagnostic criteria of infarct morphology on DWI and magnetic resonance angiography,the mechanism of stroke was divided into carrier artery occlusion perforator artery and non-carrier artery occlusion perforator artery.Among the non-carrier artery occlusion perforator artery group,artery-to-artery embolization group,hypoperfusion/decreased embolus removal group,and mixed stroke group were included.HR-MRI was used to analyze the atherosclerotic plaque characteristics in the M1 segment of MCA,and the correlation between plaque characteristics and perforator artery infarction caused by carrier artery occlusion was explored.Results:A total of 232 intracranial atherosclerotic plaques were analyzed in 232 patients(146 in the perforator artery group with non-carrier artery obstruction and 86 in the perforator artery group with carrier artery obstruction).Compared with the carrier artery occlusion perforator group,the reconstruction index in the non-carrier artery occlusion perforator group was smaller(0.97[0.73,1.13]vs.1.02[0.90,1.12],P=0.028),the patch length was larger(9.90 mm[6.70 mm-13.20 mm]versus 8.25 mm[6.60 mm-10.30 mm],P=0.013),the plaque thickness was larger(1.50 mm[1.35 mm-1.90 mm]vs.1.37 mm[1.21 mm1.54 mm],P<0.001),and the plaque load percentage was larger(0.93[0.85,0.96]vs.0.87[0.78,0.93],P<0.001),greater stenosis(0.82[0.72,0.91]versus 0.72[0.59,0.83],P<0.001),fewer patches in the upper quadrant(10.27%versus 27.91%,P=0.002),and fewer surface irregularities(67.12%versus 47.67%,P=0.004).After adjusting for clinical demographic factors,the results of binary logistic regression analysis showed that plaque thickness was significantly thinner in the perforator artery group with carrier artery occlusion(OR 0.10,95%CI[0.04,0.27],P<0.001).The patch surface was more regular(OR 0.51,95%CI[0.27,0.95],P=0.035)and more distributed in the upper quadrant(OR 4.18,95%CI[1.37,12.80],P=0.012).Conclusion:Middle cerebral artery plaque characteristics were associated with stroke mechanism,in which plaque thickness,plaque surface irregularity,and plaque distribution predicted carrier artery occlusion and perforator artery occlusion.HR-MRI may provide new insights into the different mechanisms of middle cerebral artery infarction.