Vessel Wall MRI of Chronic Internal Carotid Artery Occlusion: Imaging Findings Associated with Recurrent Stroke

Q: What are the key findings of this study?

Distal occluded lumen hyperintensity (OR 2.86, p=0.02), ipsilateral Pcom <4 (OR 3.48, p=0.03), and left-sided lesion (OR 2.54, p=0.04) independently predicted stroke recurrence in CICAO.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Chronic internal carotid artery occlusion (CICAO) (n=188). Intervention: Distal occluded vessel lumen hyperintensity on vessel wall MRI (along with ipsilateral Pcom score <4 and left-sided lesion) vs. Absence of distal occluded vessel lumen hyperintensity (acute first stroke or chronic stroke without recurrence). Primary outcome: Acute stroke recurrence (OR 2.86, 95% CI 1.16-7.06, p=0.02).

Q: What does this research mean for the field?

Distal occluded vessel lumen hyperintensity, poor ipsilateral posterior communicating artery collateral flow, and left-sided lesions independently predict stroke recurrence in patients with chronic internal carotid artery occlusion. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Min Tang; Ling Li; Niane Ma; Jun Hu; Xin Zhang; Xuejiao Yan; Yu Wen; Xiaoyan Lei; Xiaoling Zhang

doi:10.21203/rs.3.rs-10969657/v1

October 14, 2026Open Access

Vessel Wall MRI of Chronic Internal Carotid Artery Occlusion: Imaging Findings Associated with Recurrent Stroke

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Key result

Distal occluded lumen hyperintensity is linked to ~2.9-fold higher odds of stroke recurrence in CICAO.

OR 2.86
95% CI 1.16-7.06
P=0.02
n=188

Why the study?

The study aimed to identify vessel wall magnetic resonance imaging (VWI) features predictive of stroke recurrence in patients with chronic internal carotid artery occlusion (CICAO).

Do high-resolution vessel wall magnetic resonance imaging (HR-VWI) features predict acute stroke recurrence in patients with chronic internal carotid artery occlusion (CICAO)?

Key Points

To identify vessel wall magnetic resonance imaging features predictive of stroke recurrence in patients diagnosed with chronic internal carotid artery occlusion.
Retrospectively analyzed 188 patients with chronic internal carotid artery occlusion examined by high-resolution vessel wall MRI between October 2018 and September 2025.
Categorized patients into three cohorts: acute recurrent stroke (group 1, n=75), acute first stroke (group 2, n=35), and chronic stroke (group 3, n=78) to compare clinical and imaging characteristics.
Distal occluded vessel lumen hyperintensity occurred in 52% of group 1 versus 25.7% of group 2 (P = 0.01) and 16.7% of group 3 (P < 0.001).
An ipsilateral posterior communicating artery score ≥ 4 points was noted in 37.3% of group 1, 14.3% of group 2, and 55.1% of group 3 (P group 1 vs. group 2 = 0.014; P group 1 vs. group 3 = 0.027).
Multivariate analysis showed stroke recurrence was independently predicted by left-sided lesions (OR, 2.54; 95% CI: 1.05–6.14; P = 0.04), distal lumen hyperintensity (OR, 2.86; 95% CI: 1.16–7.06; P = 0.02), and ipsilateral Pcom score < 4 (OR, 3.48; 95% CI: 1.15–10.55; P = 0.03).

Study Design

Type

Observational (n=188)

Blinding

Blinded outcome assessment (two neuroradiologists blinded to clinical information)

Multicenter

No

Structured PICO

Do high-resolution vessel wall magnetic resonance imaging (HR-VWI) features predict acute stroke recurrence in patients with chronic internal carotid artery occlusion (CICAO)?

P

Population

188 patients (mean age ~66.8 years, 17.6% female) with chronic internal carotid artery occlusion (>4 weeks confirmed by DSA) and ischemic stroke evaluated retrospectively by vessel wall MRI.

E

Exposure

High-resolution vessel wall magnetic resonance imaging (HR-VWI) using a 3.0T MRI scanner, including 3D-T1WI-VISTA, contrast-enhanced 3D-T1WI-VISTA (with intravenous gadoterate meglumine 0.1 mmol/kg over 5 minutes), BB-T1WI, and BB-T2WI

C

Comparator

Comparison across three clinical stroke status groups: Group 1 (acute recurrent stroke, n=75) vs. Group 2 (acute first stroke, n=35) vs. Group 3 (chronic stroke, n=78)

O

Outcome

Acute stroke recurrence diagnosed by imaging (VWI, routine MRI, and DWI) within 4 weeks of stroke recurrence after presentationhard clinical

Main Result

Odds Ratio: 2.86 (95% CI 1.16–7.06)

Absolute Event Rate: 52% vs 16.7%

p-value: p=0.02

Limitations

Retrospective single-center observational study with a small sample size, making selection bias likely.
Results need to be confirmed in large longitudinal studies.
Vessel wall imaging (VWI) can evaluate the degree of formation of primary and secondary collateral circulation, but cannot clarify the direction of collateral blood flow.
Retrospective single-center observational study with a small sample size, so selection bias is likely.
The results of this study need to be confirmed in large longitudinal studies.
VWI can evaluate the degree of formation of primary and secondary collateral circulation but it cannot clarify the direction of collateral blood flow.

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Answers are grounded in this paper and cite their sources.

Implication

In patients with chronic internal carotid artery occlusion, high-resolution vessel wall MRI findings of distal occluded vessel lumen hyperintensity, poor ipsilateral primary collateral flow (Pcom score < 4), and left-sided lesions independently predict a higher risk of ischemic stroke recurrence.

Abstract

Purpose The purpose of this study was to identify the vessel wall magnetic resonance imaging (VWI) features predictive of stroke recurrence in patients with chronic internal carotid artery occlusion (CICAO). Materials and methods Data of 188 patients with CICAO examined by HR-MRI from October 2018 to September 2025 were retrospectively analyzed. The 188 patients were divided into three groups: group 1 (acute recurrent stroke), group 2 (acute first stroke), and group 3 (chronic stroke). Clinical characteristics and HR-VWI vessel wall features were compared between the three groups. Results Diabetes prevalence, elevated HbA1c, left-sided lesion, and hyperintensity in distal occluded vessel lumen were significantly more common in group 1 than in group 2 or group 3 (diabetes, P all = 0.029; HbA1c, P group 1 vs. group 3 = 0.01; left-sided lesion, P group 1 vs. group 2 = 0.012, P group 1 vs. group 3 = 0.003; hyperintensity in distal occluded vessel lumen, P group 1 vs. group 2 = 0.01; P group 1 vs. group 3 < 0.001). Ipsilateral posterior communicating (Pcom) score ≥ 4 points was significantly less common in groups 1 and 2 than in group 3 (37.3% vs. 14.3% vs. 55.1%; P group 1 vs. group 2 = 0.014, P group 2 vs. group 3 < 0.001, P group 1 vs. group 3 = 0.027), and was higher in group 1 than in group 2. FLAIR vascular hyperintensity (FVH) was significantly more common in groups 1 and 2 than in group 3 (60% vs. 61.33% vs. 24%; P group 1 vs. group 3 < 0.001, P group 2 vs. group 3 < 0.001). In multivariate analysis, the independent predictors of stroke recurrence were left-sided lesion (OR, 2.54; 95% CI: 1.05–6.14, P = 0.04), distal occluded vessel lumen hyperintensity (OR, 2.86; 95% CI: 1.16–7.06; P = 0.02), and ipsilateral Pcom score < 4 (OR, 3.48; 95% CI: 1.15–10.55, P = 0.03). Conclusion Patients with left-sided lesion, distal occluded vessel lumen hyperintensity, and poor primary collateral flow have higher risk of CICAO stroke recurrence.

Discussion

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Cite This Study

Tang et al. (2026) conducted an observational in Chronic internal carotid artery occlusion (CICAO) (n=188). Distal occluded vessel lumen hyperintensity on vessel wall MRI (along with ipsilateral Pcom score <4 and left-sided lesion) vs. Absence of distal occluded vessel lumen hyperintensity (acute first stroke or chronic stroke without recurrence) was evaluated on Acute stroke recurrence (OR 2.86, 95% CI 1.16-7.06, p=0.02). Distal occluded lumen hyperintensity (OR 2.86, p=0.02), ipsilateral Pcom <4 (OR 3.48, p=0.03), and left-sided lesion (OR 2.54, p=0.04) independently predicted stroke recurrence in CICAO.

synapsesocial.com/papers/6aee6b6871a759480622094c https://doi.org/10.21203/rs.3.rs-10969657/v1

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Vessel Wall MRI of Chronic Internal Carotid Artery Occlusion: Imaging Findings Associated with Recurrent Stroke

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Vessel Wall MRI of Chronic Internal Carotid Artery Occlusion: Imaging Findings Associated with Recurrent Stroke

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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