ABSTRACT NUMBER: ESOC2026A486 PLAQUE CHARACTERISTICS AND STROKE RECURRENCE IN SYMPTOMATIC INTRACRANIAL STENOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background and aims Intracranial atherosclerotic stenosis (ICAS) is a major cause of ischemic stroke (IS) and transient ischemic attack (TIA). Plaque characteristics can be assessed using vessel wall magnetic resonance imaging (vwMRI). We aimed to synthesize evidence on the associations between vwMRI plaque features and recurrent IS/TIA in medically treated symptomatic ICAS (sICAS). Methods We systematically searched the literature (past 20 years) for relevant studies. The primary outcome was recurrent IS/TIA in the same territory; the secondary outcome was any recurrent IS/TIA during follow-up. Effect estimates were pooled as mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CIs) for each plaque feature using random-effects models. For the primary outcome, leave-one-out sensitivity analyses were conducted. Results Overall, 25 studies (n=3,760) were eligible for systematic review, among which 23 studies (n=3,333) were included in meta-analysis for 20 plaque metrics. Patients with a primary outcome had significantly larger plaque burden (n=1,101, MD=0.04, 95% CI 0.02-0.05) and higher enhancement ratio (n=478, MD=0.31, 0.10-0.51), and were more likely to have positive remodeling (n=775, RR=1.58, 1.09-2.29), irregular plaque surface (n=469, RR=1.72, 1.03-2.89), and significant plaque enhancement (n=738, RR=2.47, 1.71-3.56). Findings remained consistent in sensitivity analyses. Moreover, positive remodeling (n=460, RR=1.67, 1.15-2.43), any plaque enhancement (n=922, RR=2.53, 1.67-3.85), significant plaque enhancement (n=363, RR=1.78, 1.19-2.68), and intraplaque hemorrhage (n=784, RR=1.62, 1.01-2.61) were significantly associated with the secondary outcome. Conclusions Plaque features assessed on vwMRI were associated with same-territory and any IS/TIA recurrence in medically treated sICAS patients, which can facilitate stroke risk stratification. Conflict of interest Yue Gu, Chao Zhang, Xuan Tian, Yue Wang, Thomas W Leung, Binbin Sui, Xinyi Leng: nothing to disclose.