BACKGROUND It is still unknown that whether co-existing intracranial stenosis and extracranial carotid vulnerable plaques have higher predictive value for subsequent vascular events. This study aimed to determine the relationship between co-existing extracranial carotid vulnerable plaques and intracranial stenosis and subsequent vascular events utilizing cardiovascular magnetic resonance (CMR) vessel wall imaging. METHODS Patients who had recent cerebrovascular symptoms in anterior circulation (< 2 weeks) were consecutively enrolled and underwent multi-contrast CMR vessel wall imaging for extracranial carotid arteries and 3D time-of flight CMR angiography for intracranial arteries at baseline. After baseline examination, all patients were followed-up for at least 1 year to determined recurrence of vascular events. The co-existing cerebrovascular atherosclerosis was defined as presence of both intracranial artery stenosis and at least one the following measures of extracranial artery atherosclerosis: plaque, calcification, lipid-rich necrotic core (LRNC), or intraplaque hemorrhage. Univariate and multivariate Cox regressions were used to calculate the hazard ratio (HR) and corresponding 95% confidence interval (CI) of co-existing plaques in predicting subsequent vascular events. RESULTS In total, 150 patients (mean age: 61.8 ± 11.9 years; 109 males) were recruited. During the median follow-up time of 12.1 months, 41 (27.3%) patients experienced vascular events. Co-existing intracranial artery stenosis and extracranial carotid plaque (HR, 3.57; 95% CI, 1.63-7.82; P = 0.001) and co-existing intracranial artery stenosis and extracranial carotid LRNC (HR, 4.47; 95% CI, 2.15-9.27; P < 0.001) were significantly associated with subsequent vascular events, respectively. After adjusted for confounding factors and carotid stenosis, these associations remained statistically significant (HR, 5.12; 95% CI, 1.36-19.24; P = 0.016 and HR, 8.12; 95% CI, 2.41-27.31; P = 0.001, respectively). CONCLUSIONS The co-existing cerebrovascular atherosclerotic diseases, particularly co-existing carotid lipid-rich necrotic core and intracranial stenosis, are independent predictors for subsequent vascular events.

中文翻译：

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并存的脑血管动脉粥样硬化可预测随后的血管事件：一项多造影剂心血管磁共振成像研究。

背景技术尚不清楚颅内狭窄和颅外颈动脉易损斑块并存是否对随后的血管事件具有更高的预测价值。这项研究的目的是利用心血管磁共振（CMR）血管壁成像技术来确定颅内颈外易损斑块与颅内狭窄以及随后的血管事件之间的关系。方法连续招募具有前循环（<2周）近期脑血管症状的患者，并在基线时行颅脑颈动脉多对比度CMR血管壁成像和颅内动脉3D飞行时间CMR血管造影。基线检查后，对所有患者进行至少1年的随访，以确定血管事件是否复发。并存的脑血管动脉粥样硬化定义为同时存在颅内动脉狭窄和颅外动脉粥样硬化的以下至少一种测量指标：斑块，钙化，富含脂质的坏死核心（LRNC）或斑块内出血。使用单变量和多变量Cox回归来计算并存斑块的危险比（HR）和相应的95％置信区间（CI），以预测随后的血管事件。结果总共招募了150名患者（平均年龄：61.8±11.9岁；男性109名）。在中位随访时间12.1个月中，有41名（27.3％）患者经历了血管事件。颅内动脉狭窄和颅外颈动脉斑块并存（HR，3.57; 95％CI，1.63-7.82; P = 0.001），并存颅内动脉狭窄和颅外颈动脉LRNC（HR，4.47; 95％CI，2.15-9.27；P <0.001）分别与随后的血管事件显着相关。在对混杂因素和颈动脉狭窄进行调整后，这些关联仍然具有统计学意义（HR，5.12； 95％CI，1.36-19.24； P = 0.016； HR，8.12； 95％CI，2.41-27.31； P = 0.001）。结论并存的脑血管动脉粥样硬化性疾病，尤其是并存的富含颈动脉脂质的坏死核心和颅内狭窄，是随后血管事件的独立预测因子。分别）。结论并存的脑血管动脉粥样硬化性疾病，尤其是并存的富含颈动脉脂质的坏死核心和颅内狭窄，是随后血管事件的独立预测因子。分别）。结论并存的脑血管动脉粥样硬化性疾病，尤其是并存的富含颈动脉脂质的坏死核心和颅内狭窄，是随后血管事件的独立预测因子。