Combination of culprit plaque enhancement ratio and hypoperfusion contributes to short-term outcomes of patients with atherosclerotic stenosis in the middle cerebral artery.

OBJECTIVE: To investigate the differences in intracranial culprit plaque characteristics in the middle cerebral artery (MCA) and in hypoperfusion between patients with and without favourable functional outcomes and to explore the association of functional outcome of patients with ischaemic cerebrovascular events.

METHODS: A total of 121 patients with acute/subacute ischaemic stroke stemming from atherosclerotic plaques in the MCA were retrospectively enrolled and grouped into patients with favourable functional outcomes and those with unfavourable functional outcomes. Each patient underwent high-resolution vessel wall imaging and dynamic susceptibility contrast-enhanced perfusion weighted imaging on a 3.0 T MRI. Differences in culprit plaque characteristics and hypoperfusion in the territory of the stenotic MCA were evaluated between the two groups. Risk factors were determined through logistic regression analyses.

RESULTS: Higher culprit plaque enhancement ratio, lower Tmax-ASPECTS, and greater infarct volume were observed in the group with unfavourable functional outcomes (all P < .050). Both the plaque enhancement ratio and the Tmax-ASPECTS were associated with infarct volume (P = .001 and .007, respectively). The culprit plaque enhancement ratio and Tmax-ASPECTS were found to be independent factors for the outcome of patients with ischaemic stroke (all P < .050). The area under the curve of the combination of the above factors (AUC = 0.838) was significantly higher than that of any single variable after adjustment (all P < .050).

CONCLUSION: The culprit plaque enhancement ratio, Tmax-ASPECTS, and infarct volume were risk factors for functional outcome in patients with ischaemic stroke.

ADVANCES IN KNOWLEDGE: The combination improved the accuracy in predicting the 90-day functional outcome of patients with ischaemic stroke.