Intracranial Plaque Characteristics and Extracranial Carotid Plaque‐ RADS Associated With Stroke Recurrence: A High‐Resolution Vessel Wall Imaging Study

BACKGROUND: In addition to intracranial plaques, extracranial carotid plaques have also been linked to stroke recurrence. However, the association of combined intracranial and extracranial plaque characteristics with stroke recurrence remains unclear. PURPOSE: To evaluate the association between intracranial plaque features and extracranial carotid Plaque Reporting and Data System (Plaque-RADS) with stroke recurrence utilizing high-resolution vessel wall imaging (HR-VWI). STUDY TYPE: Retrospective. POPULATION: The 388 intracranial atherosclerotic ischemic stroke patients (mean age, 57.3 ± 11.5 years, 274 males). FIELD STRENGTH/SEQUENCE: 3T, three-dimensional T1 weighted 3D fast spin echo. ASSESSMENT: HR-VWI was performed in all patients within 7 days of the stroke onset. The imaging features assessed included intracranial plaque characteristics (degree of stenosis, plaque burden, enhancement ratio, remodeling index, and intraplaque hemorrhage [IPH]) and extracranial carotid Plaque-RADS. Patients enrolled between May 2022 and July 2024 were included in the study. All patients were followed for a minimum of 12 months. STATISTICAL TESTS: test, univariate and multivariate Cox regression analyses, time-dependent ROC and AUC curves, and Kaplan-Meier survival curves. p-values less than 0.05 were regarded as statistically significant. RESULTS: During a median follow-up period of 24 months, 55 patients experienced recurrent stroke. Intracranial plaque enhancement ratio (HR, 1.62; 95% CI, 1.11-2.38), IPH (HR, 2.55; 95% CI, 1.47-4.40), and extracranial carotid Plaque-RADS (HR, 2.23; 95% CI, 1.29-3.86) were significantly associated with stroke recurrence. Time-dependent ROC indicated that the maximum AUCs for enhancement ratio, IPH, and Plaque-RADS were 0.75, 0.69, and 0.68, respectively, while the Cox model including all three reached a maximum AUC of 0.79. DATA CONCLUSION: The combination of intracranial plaque characteristics and extracranial carotid Plaque-RADS can be used to assess ischemic stroke recurrence. EVIDENCE LEVEL: 3. TECHNICAL EFFICACY: Stage 2.