DOI: 10.1161/jaha.126.049677 ISSN: 2047-9980

Intraplaque Hemorrhage in Chronic Anterior Circulation Arterial Occlusion: Associated Factors and Vessel‐Specific Patterns on High‐Resolution Magnetic Resonance Imaging

Yaping Meng, Lingmin Zhao, Tao Chen, Shoufeng Liu, Shenna Niu, Chengcheng Cui, Yajing Wang, Wei Wang, Yilin Ma, Yue Zhang, Yuxin Xing, Kai Zheng, Ying Cai, Jieli Chen, Jialing Wu
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Background

Chronic anterior circulation arterial occlusion, particularly involving the internal carotid artery or middle cerebral artery (MCA), carries a persistent risk of ischemic events. Intraplaque hemorrhage (IPH) is a marker of plaque instability, but its prevalence, vessel‐specific distribution, and clinical correlates in chronic anterior circulation arterial occlusion remain unclear.

Methods

We retrospectively enrolled 210 patients with chronic anterior circulation arterial occlusion who underwent high‐resolution magnetic resonance imaging between January 2024 and March 2025. IPH was identified by T1‐weighted hyperintensity within the vessel wall. Clinical and vascular risk factors, imaging, and laboratory factors associated with IPH were analyzed using logistic regression, including analyses stratified by occlusion site.

Results

IPH was detected in 86 (41.0%) and was more frequent in internal carotid artery than MCA occlusion (60.5% versus 38.4%). Patients with IPH were more frequently male, had more smoking history, lower platelet counts, higher creatinine levels, and more recent acute ischemic stroke. In multivariable analysis, recent acute ischemic stroke (adjusted odds ratio [aOR], 2.08 [95% CI, 1.10–3.94]) and occlusion location (MCA versus internal carotid artery, aOR, 0.51 [95% CI, 0.27–0.95]) were independently associated with IPH. Intracranial internal carotid artery occlusion showed a lower likelihood of IPH in univariable analysis, with directionally consistent associations after adjustment (OR, 0.26 [95% CI, 0.09–0.79]), whereas recent acute ischemic stroke remained independently associated with IPH in MCA occlusion (aOR, 3.12 [95% CI, 1.19–8.20]).

Conclusions

IPH is common in chronic anterior circulation arterial occlusion and shows vessel‐specific patterns. Its association with recent ischemic stroke, particularly in MCA occlusion, suggests persistent plaque activity in some chronically occluded arteries. High‐resolution magnetic resonance imaging may help characterize plaque phenotype and improve risk assessment in chronic occlusive cerebrovascular disease.

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