The Predictive Value Of MR-VWI In The Efficacy And Safety Of Interventional Therapy For Intracranial Atherosclerotic Stenosis

Objective: The purpose of this study was to investigate the predictive value of magnetic resonance vessel wall imaging(MR-VWI)in the effectiveness and safety of interventional treatment of intracranial atherosclerotic stenosis(ICAS).Methods: The clinical data of 68 patients with acute cerebral infarction or transient ischemic attack diagnosed in the Department of Neurology of the Fourth Affiliated Hospital of China Medical University from January 2019 to July 2022 were collected,and the MR-VWI examination and intracranial artery intervention treatment were completed.According to the stability of atherosclerotic plaque in the responsible vessels indicated by MR-VWI,they were divided into stable plaque group(18 cases)and unstable plaque group(50 cases).By comparing the baseline data,characteristics of atherosclerotic plaque,the number of balloon expansions during operation,the rate of residual stenosis after operation,perioperative complications(ischemic stroke,dizziness,nausea,pneumonia,cerebral hemorrhage,death),the good prognosis 90 days after stenting,and the occurrence of major end points of the two groups,to analyze the effect of plaque stability on the effectiveness and safety of ICAS intravascular interventional therapy.According to the artery where the responsible plaque is located,it is divided into middle cerebral artery(MCA)group(37cases)and basilar artery(BA)group(31 cases).The risk factors of different intracranial arteries and the effectiveness and safety of intravascular interventional therapy are analyzed.Results: Compared with the stable plaque group,the patients in the unstable plaque group had more involvement of the responsible vessel perforations(22.22% vs 52%,P=0.029),lower low density lipoprotein level [2.39(1.83,2.91)vs 1.89(1.48,2.20),P=0.037],and more balloon dilation times [1(1,2)vs 2(1,3),P=0.005],with a statistically significant difference.Compared with the MCA group,the patients in the BA group were older [57(29,65.5)vs 66(57,68),P=0.01],the proportion of women was lower(37.84% vs 12.9%,P=0.02),the number of perforations involved was more(27.03% vs 64.52%,P=0.002),the proportion of positive remodeling was more(24.32% vs 48.39%,P=0.039),the length of lesions was longer [6(5,8)vs 8(6,11),P=0.035],and the number of balloon dilations during operation was more [1(1,2)vs 2(2,3),P=0.000],The proportion of high residual stenosis at the lesion site after operation was higher(5.4% vs 25.81%,P=0.035),with statistically significant difference.Conclusion:1.Unstable plaques are more likely to involve the perforating artery than stable plaques,and the responsible artery with unstable plaques requires more balloon dilation during interventional treatment.2.Compared with MCA stenosis,BA stenosis is more likely to involve the perforating artery,exhibit positive remodeling,have a longer lesion length,and have a higher frequency of balloon dilation during intravascular intervention treatment.3.There is no significant difference in the effectiveness and safety of ICAS intervention therapy with stable or unstable plaques;BA is more prone to postoperative high residual stenosis than MCA,and there is no significant difference in perioperative complications and short-term prognosis between the two groups.