Combined Assessment of Elevated Plasma Lipoprotein-Associated Phospholipase A₂ and Plaque Enhancement Improved Accuracy in the Risk of Acute Ischemic Stroke in Patients with Intracranial Artery Stenosis

Purpose: We evaluated the relationship between plasma lipoprotein-associated phospholipase A₂ (Lp-PLA₂) concentration and plaque characteristics in patients with intracranial artery stenosis and their clinical relevance in acute ischemic stroke.

Methods: Eighty-seven patients with intracranial atherosclerotic stenosis (66 males, 21 females) were retrospectively enrolled. Plasma Lp-PLA₂ concentration was measured, and vessel wall magnetic resonance imaging (VW-MRI) was used to determine intracranial vascular stenosis and plaque characteristics, including plaque enhancement, surface morphology, and T₁ hyperintensity. Binary logistic regression was used to evaluate the relationship between Lp-PLA₂ concentration and plaque characteristics of intracranial artery after adjusting for demographic and confounding factors and to assess their diagnostic efficacy for the risk of acute ischemic stroke.

Results: After adjustment for demographic, medication and related lipid factors, Lp-PLA₂ elevation was associated with plaque enhancement (odds ratio [OR]=12.7, 95% confidence interval [CI] 2.51-64.82, P=0.002) and surface irregularity (OR=2.9, 95% CI 1.06-7.98, P=0.038). Both Lp-PLA₂ elevation (OR=8.8, 95% CI 1.64-47.72, P=0.011) and plaque enhancement (OR=34.3, 95% CI 5.88-200.4, P=0.001) were associated with acute ischemic stroke. Receiver operating characteristic curve analysis showed that the area under the curve for Lp-PLA₂ concentration and plaque enhancement combined in the diagnosis of acute ischemic stroke was 0.884, significantly higher than that for Lp-PLA₂ concentration (0.724) and plaque enhancement (0.794) alone.

Conclusion: Elevated Lp-PLA₂ is associated with plaque enhancement and plaque surface irregularity. Combined assessment of Lp-PLA₂ concentration and plaque enhancement is of greater diagnostic value for the risk of acute ischemic stroke in patients with intracranial artery stenosis.