Geometric characteristics of Middle Cerebral Artery Atherosclerosis and Clinical Stroke: An Observational Study (P5.227)

Objective: We aimed to systematically investigate the geometric characteristics of middle cerebral artery (MCA) atherosclerosis and its association with stroke. Background: Evidence indicates that geometric characteristics of extracranial atherosclerosis play a role in cardiovascular events. However, evidence is lacking in the geometric characteristics of intracranial atherosclerosis and its association with stroke. Design/Methods: We reviewed our institutional prospectively-collected data of vessel wall magnetic resonance imaging between Jan 2007 and Aug 2015. Patients with MCA atherosclerosis and a first-ever stroke in MCA territory, with asymptomatic MCA atherosclerosis, or without MCA atherosclerosis were included. Geometric characteristics of MCA atherosclerosis, including M1 segment shape, plaque location, plaque length and thickness, stenosis degree, and remodeling ratio, were assessed. The association between geometric characteristics and stroke was analyzed. Results: A total of 1006 MCAs were analyzed, including 124 atherosclerotic MCAs with stroke, 457 atherosclerotic asymptomatic MCAs, and 429 plaque-free MCAs. Curved MCAs were more prevalent than straight MCAs (79.2% vs 20.2%). Inferior-oriented M1 curve (61.5%) was the most prevalent, followed by ventral, superior, and dorsal-oriented curves. Plaque involved the inner wall of 90·4% curved atherosclerotic MCA. The absence of inferior-oriented M1 curve (OR 0.54, 95% CI 0.35–0.83), presence of superior plaque (OR 2.42, 95% CI 1.52–3.86), greater plaque length (OR 1.14, 95% CI 1.07–1.22), greater plaque thickness (OR 2.55, 95% CI 1.49–4.36), higher remodeling ratio (OR 1.15, 1.04–1.27), and fewer quadrants involved by plaque (OR 0.68, 95% CI 0.51–0.91) were independently associated with stroke. Conclusions: Geometric characteristics of MCA atherosclerosis are relevant to stroke occurrence and potentially valuable for individual stroke stratification. Our results provide insights into the vascular pathophysiology of intracranial atherosclerosis. Study Supported by: National Natural Science Foundation of China, Capital Health Research and Development of Special Fund, 2016 PUMCH science fund for junior faculty. Disclosure: Dr. Yu has nothing to disclose. Dr. Li has nothing to disclose. Dr. Xu has nothing to disclose. Dr. Trieu has nothing to disclose. Dr. Gao has nothing to disclose. Dr. Feng has nothing to disclose. Dr. Liebeskind has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Stryker, Medtronic. Dr. Xu has nothing to disclose.