Risk of acute cerebral infarction in patients with hypertension based on high-resolution MRI.

Background: Hypertension is associated with both carotid plaque formation and acute cerebral infarction (ACI). We aim to investigate the correlation between high-resolution magnetic resonance imaging (HR-MRI) characteristics of vulnerable carotid plaques and the severity of ipsilateral ACI in patients with hypertension.

Methods: A retrospective collection of HR-MRI carotid plaque of patients with hypertension was conducted. Using hyperintensity on diffusion-weighted imaging, the patients were divided into the ACI and non-ACI groups. Based on the National Institutes of Health Stroke Scale (NIHSS) scores, ACI was further classified into mild ACI and moderate-to-severe ACI. Logistic regression analysis was conducted to explore the relationship among demographic and laboratory examination information, plaque characteristics, and ipsilateral ACI.

Results: Among the 162 patients recruited, 68 (42%) with hypertension and ACI had a longer duration of hypertension, higher hypertension grade, higher serum creatinine levels, and higher HbA1c levels (P<0.05 for all). In addition, the proportions of both intraplaque hemorrhage (IPH) and plaque enhancement were higher in the ACI group (P<0.05). The duration of hypertension [odds ratio (OR), 1.06; P=0.02], higher hypertension grades [grade 2 (OR, 3.05; P=0.011) and grade 3 (OR, 2.71; P=0.039)], serum creatinine levels (OR, 1.03; P=0.023), IPH (OR, 2.89; P=0.004) and plaque enhancement (OR, 2.37; P=0.029) were identified as the risk factors for the occurrence of ACI. Grade 3 hypertension (OR, 4.67; P=0.023) and surface irregularity (OR, 4.09; P=0.032) were related to the more severe form of ACI (NIHSS >5).

Conclusions: The grade and duration of hypertension and the characteristics of carotid plaques based on HR-MRI associated with the occurrence and severity of ipsilateral ACI.