Plaque features and lenticulostriate artery morphology in unexplained early neurological deterioration in symptomatic MCA stenosis: A 7 T MRI study.

Background: A large proportion of early neurological deterioration (END) in stroke due to middle cerebral artery (MCA) stenosis remains unexplained. Unstable plaques on MCA and impaired perforators might contribute to unexplained END.

Methods: We included patients with symptomatic MCA stenosis and classified them into three groups according to symptoms: END, stable, and transient ischemic attack (TIA). High-resolution 7 T vessel wall magnetic resonance imaging (MRI) (VW-MRI) and time-of-flight magnetic resonance (MR) angiography (TOF-MRA) were used to investigate MCA plaque features and lenticulostriate artery (LSA) morphology. We compared demographic data, plaque features and LSA morphology between three groups, and used binary logistic regression models to investigate factors that could potentially be related to END.

Results: Fifty-two patients (49.46 ± 13.94 years, 39 males) were included in final analyses. Patients in three groups did not differ in age or vascular risk factors. Irregular plaque surface (16/16 vs 12/16 vs 11/20 in END vs stable vs TIA groups, P = 0.008) and plaques adjacent to LSA origin (14/16 vs 10/16 vs 7/20, P = 0.006) were more commonly seen in the END group than the other two groups. On TOF-MRA, TIA patients had more LSA branches (6[1,15] vs 5[1,9] vs 7[4,12] in END vs stable vs TIA groups, P = 0.018) and longer total LSA length (95.37 ± 43.98 vs 92.42 ± 33.10 vs 129.61 ± 38.77 mm, P = 0.012). Larger lesion size, higher LDL level and plaques adjacent to LSA origin were significantly associated with END, before and after the adjustment for age and sex.

Conclusion: The 7 T MRA provide precise imaging capabilities for plaque characteristics and LSA in patients with MCA stenosis and END, which could help stratify the risks of END and provide evidence for treatment of ischemic stroke caused by MCA arthrosclerosis.