Abstract Background and aims Intracranial atherosclerotic stenosis (ICAS) is one of the major causes of stroke worldwide, especially in Asia. The high-resolution MR vessel wall imaging (HR-MRI) could evaluate atherosclerotic plaque characteristics in ICAS patients. We aimed to explore the distribution of atherosclerotic plaque using HR-MRI and study its impact on balloon angioplasty and prognosis. Methods Between September 2020 and September 2024, a total of 67 ICAS patients underwent HR-MRI upon admission, of which 45 patients underwent balloon angioplasty. We collected demographic characteristics, laboratory data, imaging features, surgical treatment data, and postoperative follow-up information. According to the quadrant distribution of plaques, we introduced the new concepts of "continuous plaques" and "intermittent plaques" to comprehensively study the impact of plaque distribution characteristics on balloon angioplasty. Results Among the 67 patients, there were 47 patients with continuous distribution of plaques and 20 patients with intermittent distribution. High density lipoprotein (HDL) and lymphocyte-to-monocyte ratio (LMR) are significantly correlated with plaque distribution and could predict the plaque distribution characteristics of ICAS patients. Receiver operating characteristic curves were established to compare the predictive abilities of HDL and LMR, and HDL was a better indicator to predict plaque distribution characteristics. Patients with plaques occupying four quadrants had a lower rate of vascular stenosis after the last balloon dilation. Within one year of postoperative follow-up, patients with continuous plaques had lower mRS scores. Conclusions Inflammatory and lipid markers can predict the distribution of atherosclerotic plaque in ICAS patients. The distribution characteristics of plaque quadrants have potential guiding value for balloon dilation surgery. Conflict of interest Shumeng Li: nothing to disclose
Li et al. (Fri,) studied this question.