{
  "abstract": "Background Intracranial plaque enhancement (IPE) on high-resolution magnetic resonance imaging (HR-MRI) after the administration of contrast gadolinium, has been associated with a greater likelihood of acute ischemic stroke (AIS). However, prior studies have been limited by retrospective design, single-center cohorts, and subjective assessment of enhancement. We aimed to objectively quantify IPE in a prospective multicenter cohort and evaluate its association with recurrent AIS.Methods We conducted a prospective multicenter study including one center in China and one center in the United States. Patients with AIS attributed to intracranial atherosclerotic disease (ICAD) who underwent 3T HR-MRI at baseline and follow-up were included. Atherosclerotic plaques were identified on HR-MRI, and imaging was processed to generate three-dimensional (3D) IPE maps. These post-acquisition processing allows the objective quantification of enhancement. Only plaques located within the vascular territory of the index stroke were analyzed. In patients with multiple plaques, the most stenotic lesion was selected. Plaque morphological metrics, including plaque burden and stenosis severity according to Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) criteria were obtained. Changes in IPE, degree of stenosis, and plaque burden from baseline to follow-up were longitudinally assessed. The primary outcome was a new AIS attributed to ICAD on follow-up imaging. Multivariable logistic regression was performed to evaluate factors associated with recurrent AIS.Results A total of 53 patients with AIS attributed to ICAD were included. The mean interval between baseline and follow-up imaging was 400 days (standard deviation: 100 days). During follow-up, 15 of 53 patients (28.3%) developed a new AIS attributed to ICAD. Changes in degree of stenosis (-31% vs -61%, p=0.27) and plaque burden (-11% vs -17%, p=0.48) did not differ between patients with and without recurrent AIS. In contrast, IPE was different between groups (-0.01% vs -38%, p=0.002). On multivariable logistic regression, change in degree of stenosis (OR 1.07, 95% CI 0.47-3.07, p=0.86) and plaque burden (OR 1.04, 95% CI 0.03-2.34, p=0.97) were not associated with recurrent AIS. However, persistence or increase in IPE on follow-up HR-MRI was associated with a higher risk of recurrent AIS (OR 8.33, 95% CI 1.53-80.38, p=0.03).Conclusion The risk of recurrent AIS in patients with ICAD may be determined by the degree of IPE, and not by morphological changes.Disclosures A. Gudino: None. B. Tian: None. M. Hinojosa-Figueroa: None. D. Sharma: None. A. Ashok: None. S. Biswas: None. G. Anil-Peethambar: None. A. Rivadeneira-Limongi: None. J. Manrique: None. M. Godoy: None. L. Gudino: None. C. Dier: None. C. Zhu: None. E. Samaniego: None.Abstract P-032 Figure 1(A) Atherosclerotic plaque showed higher IPE on baseline and reduced on (B, C) follow-up. The patient didn’t develop AIS on follow-up. (D) Atherosclerotic plaque avidly enhanced on baseline and (E, F) follow up. The patient had a new AIS on follow-up",
  "authors": [
    {
      "affiliations": [
        "Neurology, University of Iowa, Iowa City, IA"
      ],
      "name": "A Gudino"
    },
    {
      "affiliations": [
        "Neurology, Changhai Hospital, Changhai, China"
      ],
      "name": "B Tian"
    },
    {
      "affiliations": [
        "Neurology, University of Iowa, Iowa City, IA"
      ],
      "name": "M Hinojosa-Figueroa"
    },
    {
      "affiliations": [
        "Neurology, University of Iowa, Iowa City, IA"
      ],
      "name": "D Sharma"
    },
    {
      "affiliations": [
        "Neurology, University of Iowa, Iowa City, IA"
      ],
      "name": "A Ashok"
    },
    {
      "affiliations": [
        "Neurology, University of Iowa, Iowa City, IA"
      ],
      "name": "S Biswas"
    },
    {
      "affiliations": [
        "Neurology, University of Iowa, Iowa City, IA"
      ],
      "name": "G Anil-Peethambar"
    },
    {
      "affiliations": [
        "Neurology, University of Iowa, Iowa City, IA"
      ],
      "name": "A Rivadeneira-Limongi"
    },
    {
      "affiliations": [
        "Neurology, University of Iowa, Iowa City, IA"
      ],
      "name": "J Manrique"
    },
    {
      "affiliations": [
        "Neurology, University of Iowa, Iowa City, IA"
      ],
      "name": "M Godoy"
    },
    {
      "affiliations": [
        "Neurology, University of Iowa, Iowa City, IA"
      ],
      "name": "L Gudino"
    },
    {
      "affiliations": [
        "Neurology, University of Iowa, Iowa City, IA"
      ],
      "name": "C Dier"
    },
    {
      "affiliations": [
        "Neurology, University of Iowa, Iowa City, IA"
      ],
      "name": "N Shenoy"
    },
    {
      "affiliations": [
        "Radiology, University of Washington, Seatle, WA"
      ],
      "name": "C Zhu"
    },
    {
      "affiliations": [
        "Neurology, University of Iowa, Iowa City, IA"
      ],
      "name": "E Samaniego"
    }
  ],
  "title": "P-032 Plaque wall enhancement is associated with recurrent ischemic stroke in intracranial atherosclerotic disease: a prospective multicenter study",
  "uid": "28780b53-3699-5f30-b7ca-f29c7db695eb"
}