Diabetes-specific characteristics of intracranial artery atherosclerosis: a magnetic resonance vessel wall imaging study

Background

While diabetes mellitus (DM) is an established risk factor for intracranial atherosclerotic disease (ICAD), its impact on plaque characteristics across different intracranial vascular territories remains unclear.

Methods

Patients with symptomatic intracranial artery stenosis were recruited from a multi-center study of ICASMAP. Plaque characteristics, including the location, plaque burden measured by normalized wall index (NWI), luminal stenosis, length, T1 hyperintense, enhancement grade, and the enhancement ratio of atherosclerotic plaques were evaluated. Plaque characteristics were compared between patients with and without DM and the association between DM and plaque characteristics was analyzed.

Results

Of 171 recruited patients (mean age: 59.1 ± 8.9 years; 91 males), 76 (44.4 %) had DM. Diabetic patients had significantly greater luminal stenosis (49.6 %±25.6 % vs. 29.3 %±18.0 %, P < 0.001), length of plaque (9.3 ± 2.9 mm vs. 7.9 ± 3.9 mm, P = 0.001), NWI (82.9 %±13.0 % vs. 75.9 %±15.4 %, P = 0.012), plaque enhancement Grade 0 (22.4 % vs. 48.0 %, P = 0.005), and plaque enhancement Grade 1 (72.4 % vs. 48.0 %, P = 0.009) in the ophthalmic and communion segment of the internal carotid artery compared with non-diabetic patients. In the basilar artery, there were significant differences in luminal stenosis (57.5 %±28.3 % vs. 42.5 %±25.8 %, P = 0.026), length of plaque (16.6 ± 8.2 mm vs. 10.2 ± 5.3 mm, P < 0.001), and plaque enhancement Grade 1 (77.1 % vs. 51.4 %, P = 0.025) between diabetic and non-diabetic patients. No significant differences were observed in the M1-2 segment of the middle cerebral artery or the V4 segment of the vertebral artery. Adjusting for confounding factors, the differences remained statistically significant in luminal stenosis (P = 0.001), NWI (P = 0.011), plaque enhancement Grade 1 (P = 0.033), and plaque enhancement Grade 2 (P = 0.048) in the ophthalmic and communion segments of internal carotid artery and luminal stenosis (P = 0.001), length of plaque (P = 0.006) in basilar artery between diabetic and non-diabetic patients.

Conclusion

DM differentially affects atherosclerotic plaque characteristics across intracranial artery segments, predominantly the ophthalmic and communion segments of the internal carotid artery and basilar artery.