Effects of statins on plaque characteristics of intracranial atherosclerosis assessed by high-resolution magnetic resonance imaging

Objective To investigate clinical factors associated with unstable intracranial plaques and examine the relationship between pre-stroke statin use and plaque instability using high-resolution magnetic resonance imaging (HR-MRI). Methods In this retrospective cross-sectional study, we enrolled 116 patients with acute anterior circulation cerebral infarction (within 7 days of onset) due to symptomatic intracranial atherosclerosis, all of whom underwent HR-MRI during hospitalization. Based on pre-stroke statin exposure, patients were grouped into a no-statin group and a statin-treatment group; based on culprit-plaque enhancement, they were further divided into enhancement and non-enhancement groups. Using HR-MRI, we systematically evaluated vascular morphometrics of the culprit artery (vessel area, lumen area, degree of stenosis, and remodeling index) and plaque activity parameters (enhancement grade). Results Eighteen patients (15.5%) had used statins prior to stroke onset. Compared with the no-statin group, the statin group had significantly lower total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and non–high-density lipoprotein cholesterol (non-HDL-C) ( p = 0.001, p < 0.001, p < 0.001). Infarct-pattern distributions differed between groups ( p = 0.023): in the statin group, deep-only infarcts (50.0%) and cortical-only infarcts (33.3%) were more frequent, whereas large cortical/cortical–deep infarcts predominated in the no-statin group (50.0%). Plaque enhancement was less frequent in the statin group ( p = 0.015) multivariable logistic regression, identified body mass index (BMI) ( p = 0.021; OR = 1. 157; 95% CI: 1.023–1.309) and lack of statin use ( p = 0.028; OR = 3.351; 95% CI: 1.143–9.823) as independent factors associated with plaque enhancement. Conclusion Pre-stroke statin therapy stabilizes intracranial plaques by lowering lipids and suppressing plaque enhancement. It independently protects against enhancement and is associated with fewer large cortical infarctions, whereas elevated BMI is an independent risk factor for enhancement.