Quantitative imaging in medicine and surgery · 2026
Atherosclerotic plaque distribution and characteristics in young patients with stroke/transient ischemic attack: insights from MR vessel wall imaging and comparison with older counterparts.
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He Wen-Wen, Li Ting, Wang Yue, Yang Xiong, Mao Yu-Fei, Wu Fei-Yun, Shi Hai-Bin, Su Chun-Qiu, Lu Shan-Shan
Аннотация
BACKGROUND: Despite the rising global incidence of young-onset ischemic stroke-especially in East Asia, where large-vessel atherosclerosis predominates-intracranial atherosclerotic plaque distribution and imaging features in these patients remain poorly characterized. This study aimed to investigate these features in young patients with stroke or transient ischemic attack (TIA) and compare them with those in middle-aged and older patients (MOP).
METHODS: Patients aged 18-45 years (young group) and >45 years (MOP group) with recent large-vessel atherosclerotic stroke or TIA who underwent high-resolution vessel wall imaging (HRVWI) were retrospectively enrolled. Atherosclerotic risk factors, plaque-affected vessel segments, and plaque distribution were assessed. Culprit plaques were analyzed for degree of stenosis, plaque area, plaque burden, remodeling ratio, eccentricity index, plaque volume, length, intraplaque hemorrhage, enhancement ratio, and circular involvement. Quantitative measurements were obtained using semi-automated software or manual assessment when appropriate. Group comparisons were performed using χ2 tests for categorical variables and independent two-sample t‑tests or nonparametric tests for continuous variables, according to data distribution. Multivariable logistic regression analysis was performed to identify features independently associated with age.
RESULTS: A total of 244 patients were included (145 young and 99 MOP). Younger patients had significantly fewer plaque-involved vessel segments, reflected by a lower affected segment ratio (0.39±0.20 vs. 0.63±0.19, P<0.001). Age-related differences in plaque distribution were most prominent in the bilateral intracranial carotid arteries (IICA), bilateral terminal ICA (ICA-T), and the basilar artery (BA). Plaque incidence at these sites was significantly higher in the MOP group than in the young group (right IICA: 91.9% vs. 57.2%; left IICA: 93.9% vs. 57.2%; right ICA-T: 89.9% vs. 55.7%; left ICA-T: 89.0% vs. 57.8%; BA: 83.8% vs. 39.3%; all P<0.001). Within the young cohort, patients aged 36-45 years also showed significantly higher plaque incidence than those aged 18-35 years across the same five vascular sites (right IICA: 69.0% vs. 31.1%, P<0.001; left IICA: 63.0% vs. 44.4%, P=0.037; right ICA-T: 63.5% vs. 38.6%, P=0.006; left ICA-T: 63.3% vs. 45.5%, P=0.047; and BA (47.0% vs. 22.2%, P=0.005). Regarding culprit plaque morphology, the younger group exhibited lower stenosis (72.77% vs. 88.73%, P=0.031), smaller plaque area (6.66 vs. 7.37 mm2, P<0.001), lower plaque burden (0.85 vs. 0.95, P<0.001), a higher eccentricity index (0.53 vs. 0.42, P<0.001), and a significantly lower prevalence of intraplaque hemorrhage (20.00% vs. 32.32%, P=0.045). Multivariate regression analysis further identified plaque burden as an independent morphological feature associated with age (odds ratio 0.092, 95% confidence interval: 0.009-0.950, P=0.045).
CONCLUSIONS: Intracranial atherosclerosis demonstrates heterogeneous development across vascular territories. Compared with MOP, young patients with stroke exhibit a distinct plaque phenotype. Plaque burden may serve as an independent imaging marker associated with age.
METHODS: Patients aged 18-45 years (young group) and >45 years (MOP group) with recent large-vessel atherosclerotic stroke or TIA who underwent high-resolution vessel wall imaging (HRVWI) were retrospectively enrolled. Atherosclerotic risk factors, plaque-affected vessel segments, and plaque distribution were assessed. Culprit plaques were analyzed for degree of stenosis, plaque area, plaque burden, remodeling ratio, eccentricity index, plaque volume, length, intraplaque hemorrhage, enhancement ratio, and circular involvement. Quantitative measurements were obtained using semi-automated software or manual assessment when appropriate. Group comparisons were performed using χ2 tests for categorical variables and independent two-sample t‑tests or nonparametric tests for continuous variables, according to data distribution. Multivariable logistic regression analysis was performed to identify features independently associated with age.
RESULTS: A total of 244 patients were included (145 young and 99 MOP). Younger patients had significantly fewer plaque-involved vessel segments, reflected by a lower affected segment ratio (0.39±0.20 vs. 0.63±0.19, P<0.001). Age-related differences in plaque distribution were most prominent in the bilateral intracranial carotid arteries (IICA), bilateral terminal ICA (ICA-T), and the basilar artery (BA). Plaque incidence at these sites was significantly higher in the MOP group than in the young group (right IICA: 91.9% vs. 57.2%; left IICA: 93.9% vs. 57.2%; right ICA-T: 89.9% vs. 55.7%; left ICA-T: 89.0% vs. 57.8%; BA: 83.8% vs. 39.3%; all P<0.001). Within the young cohort, patients aged 36-45 years also showed significantly higher plaque incidence than those aged 18-35 years across the same five vascular sites (right IICA: 69.0% vs. 31.1%, P<0.001; left IICA: 63.0% vs. 44.4%, P=0.037; right ICA-T: 63.5% vs. 38.6%, P=0.006; left ICA-T: 63.3% vs. 45.5%, P=0.047; and BA (47.0% vs. 22.2%, P=0.005). Regarding culprit plaque morphology, the younger group exhibited lower stenosis (72.77% vs. 88.73%, P=0.031), smaller plaque area (6.66 vs. 7.37 mm2, P<0.001), lower plaque burden (0.85 vs. 0.95, P<0.001), a higher eccentricity index (0.53 vs. 0.42, P<0.001), and a significantly lower prevalence of intraplaque hemorrhage (20.00% vs. 32.32%, P=0.045). Multivariate regression analysis further identified plaque burden as an independent morphological feature associated with age (odds ratio 0.092, 95% confidence interval: 0.009-0.950, P=0.045).
CONCLUSIONS: Intracranial atherosclerosis demonstrates heterogeneous development across vascular territories. Compared with MOP, young patients with stroke exhibit a distinct plaque phenotype. Plaque burden may serve as an independent imaging marker associated with age.