ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
This article is part of the Research TopicPost-stroke Epilepsy: Risks, Prognosis, and PreventionView all 7 articles
Factors Associated with Short-Term Recurrent Ischemic Stroke: culprit plaque, collateral circulation, and pathological mechanisms
Provisionally accepted
- Shenzhen Nanshan People's Hospital, Shenzhen, China
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Purpose To investigate the predictive value of baseline plaque characteristics, perfusion injury, and pathological mechanisms for new ischemic cerebral lesions (NICLs) in medical treated patients with acute ischemic stroke (AIS) due to intracranial atherosclerotic stenosis (sICAS). Methods Retrospective analysis of AIS patients with 50-99% MCA-M1 stenosis undergoing high-resolution vessel wall MRI (HR-VWI) and CT perfusion (CTP) within one week of admission to evaluate plaque characteristics and collateral status (CS). sICAS pathogenesis was classified into three subtypes: artery-to-artery embolism (A-A), border-zone infarction (BZI), and penetrating artery occlusion, primarily based on infarct topography. Baseline clinical/imaging features and pathogenic mechanisms were compared between patients with and without NICLs during 1-year follow-up. A Cox proportional hazards regression model was employed to identify independent risk factors associated with stroke recurrence. Results Among 78 eligible patients, 25 developed NICLs, showing significantly higher adverse CS (60.0% vs 24.5%, p=0.005) and larger mismatch area (p=0.043) than non-NICLs group, with no plaque features differences. NICLs incidence varied significantly among pathogenesis subtypes (p=0.003), with baseline BZI demonstrating higher recurrence rates than A-A (56% vs 28%, p =0.001). Multivariable Cox regression analysis identified BZI (adjusted hazard ratio, 3.28 [95% CI, 1.49-7.36]; P=0.004) and unfavorable CS (adjusted hazard ratio, 2.87 [95% CI, 1.16-7.09] 2.87; p =0.011) were independently associated with the NICLs. Conclusion In the risk stratification for short-term recurrence for medically managed AIS, baseline CT perfusion deficits are prioritized over plaque imaging. Moreover, unfavorable CS as well as the pathogenic mechanism of BZI indicates compromised hemodynamics and serves as the pivotal and independent predictors of early relapse.
Keywords: High-resolution vessel wall imaging, CTP, Border zone infarcts, ischemic stroke recurrence, intracranialatherosclerotic disease
Received: 08 Oct 2025; Accepted: 28 Nov 2025.
Copyright: © 2025 Li, Hao, Shu, Chu, Zeng and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Li-ping Ma
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