Vessel wall MRI predictors of postprocedural new ischemic brain lesions after endovascular treatment for basilar artery stenosis

Abstract

Background Diffusion-weighted imaging (DWI)-detected new ischemic brain lesions (NIBL) are common complications after endovascular treatment (EVT) for basilar artery stenosis (BAS), directly impacting functional outcomes in patients. This study aimed to explore the association between vulnerable plaque markers identified by high-resolution magnetic resonance imaging (HR-MRI) and NIBL, and to clarify their predictive value for postprocedural ischemic events. Methods A total of 373 patients with BAS who underwent EVT were retrospectively enrolled in this study. Patients were classified into DWI-positive (DWI+) and DWI-negative (DWI−) groups based on the presence of NIBL on DWI within 48 hours post-procedurally. Plaque burden, distribution, remodeling type, enhancement rate, and degree of stenosis were evaluated using HR-MRI. To determine independent predictors of NIBL post-procedurally, multivariable logistic regression was applied. Results NIBL developed in 188 patients (50.4%), with a mean age of 61.76±7.83 years, including 84 males. The DWI+ group exhibited significantly higher rates of positive remodeling (PR) (51.1% vs. 37.8%, P=0.01) and plaque enhancement (PE) (87.2% vs. 75.7%, P=0.004), as well as a greater plaque burden (13.38±40.75 vs. 6.06±29.77, P=0.033), compared to the DWI− group. Multivariate logistic regression identified PE [odds ratio (OR) =2.09, 95% confidence interval (CI): 1.18–3.70, P=0.011] and PR (OR =1.77, 95% CI: 1.03–3.06, P=0.039) as independent predictors of NIBL. Conclusions HR-MRI-derived vulnerable plaque markers (PE and PR) are closely associated with the occurrence of NIBL following EVT for BAS, providing imaging-based evidence for risk stratification and treatment optimization.