Imaging Characteristics Of Basilar Artery Wall Without Or With Mild Stenosis And Its Relationship With Recent Pontine Infarction

Objective:To explore the characteristics of basilar artery wall plaque in patients with symptoms such as cerebral insufficiency and less than 50% stenosis of basilar artery on MRA images,and to explore the relationship between these characteristics and recent(within 3 months)new ischemic cerebral infarction of pons.Materials and methods:Statistics among the patients who underwent simultaneous cranial MRI plain scan,MRA examination,and high-resolution magnetic resonance vessel wall imaging(hrmr-vwi)from January 2017 to December 2022 at our institution,those who showed basilar artery wall plaque formation and stenosis < 50% determined by MRA image were reviewed 3 months after the basilar artery plaque was discovered,and a total of 146 patients were included in this study,Using a 3-month period after the initial head MR plain scan examination,patients with pontine infarcts occurring within 3 months of reviewing head MR plain scan were divided into an infarct group(70 patients),or patients without pontine infarcts occurring continuously within 3months of reviewing head MR plain scan were divided into a group without pontine infarcts(76 patients),to compare vessel wall characteristics in hrmr-vwi images of the basilar artery between the two categories of patients for analysis and to explore its association with new onset ischemic stroke in the pons within 3 months.result:1.Comparisons of gender,age,basic information(blood pressure,blood glucose and lipid profile,presence or absence of hyperhomocysteinemia(Hcy),smok-ing and alcohol abuse)between the two groups of examined subjects yielded statistically significant differences in Hcy(P = 0.047),history of alcohol abuse(P = 0.005)between the two groups.2.Alcohol abuse(P = 0.015,or2.799,95% ci1.221-6.417)was an independent risk factor for recent pontine ischemic stroke.3.Comparison of plaque characteristics on hrmr-vwi between the two groups revealed that the proportion of new pontine ischemic strokes on 3-month review was significantly higher among those who had basilar artery intraplaque hemorrhage(80.0% vs 20.0%,P < 0.001),plaque enhancement(76.5% vs 23.5%,P < 0.001),basilar artery concentric plaque(79.2% vs 20.8%,P < 0.001),and concentric enhancing plaque(91.9% vs 8.1%,P < 0.001).The proportion of enhancing plaques was significantly higher in concentric plaques(77.1% vs.22.9%,P < 0.001).Binary logistic regression analysis showed that intraplaque hemorrhage(P = 0.001,or =6.078,95% CI = 2.076-17.795),plaque enhancement(P < 0.001,or = 12.961,95% CI= 3.942-42.616)were independent risk factors for new onset ischemic stroke in the pons within 3 months.4 the plaque burden was higher in the group with pontine infarcts than in the group without pontine infarcts(60.92% ± 23.73% vs 39.61% ± 18.91%,P < 0.001).Conclusion:Unstable plaque characteristics such as intraplaque hemorrhage,plaque enhancement,concentric plaque,and plaque burden situation in the basilar artery canal wall with mild or no parenchymal stenosis were identified as risk factors for recent pontine infarctions,among which plaque enhancement and intraplaque hemorrhage were significant independent risk factors,which may provide risk stratification prediction for patients without positive MRA findings.