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As a known risk factor for atherosclerosis,type 2 diabetes mellitus(T2DM)might mediate specific features of atherosclerosis,such as vasa vasorum neovascularisation and lipid-core expansion facilitating the vulnerability of plaque lesions.This research was designed to explore the underlying correlation between carotid plaque vulnerability and ipsilateral acute cerebral infarctions(ACI)in T2DM patients suffering stroke recently.Methods 140 recent stroke patients(men,60%; mean age,63 yrs; age range 40–85 yrs)who underwent carotid and brain MRI scans in one week were included in our study.68(48.6%)of the patients had T2DM,72(51.4%)are patients without T2DM.The carotid plaque characteristics along the symptomatic side and ACI volumes of the symptomatic internal carotid artery supplying regions(ICAs)in these two group patients were evaluated and compared.Results Of the 140 enrolled stroke patients,T2DM is independent risk factor of the presence of plaque,lipid-riched necrotic core(LRNC)plaque and large LRNC plaque.Larger plaque burden as well as more large LRNC plaques were observed in T2DM patients compared to patients without T2DM,moreover,these features also found in T2DM patients with ACI in ICAs after excluded the lacunar infarction lesions.Based on receiver operating characteristic(ROC)curves analysis,predictive ability of LRNC%and luminal stenosis for ACI in ICAs was excellent for T2DM groups with a value of 0.927 and 0.916 respectively,but with significantly less ability for patients without T2DM.Predictive ability of percent wall volume(PWV)and max wall thickness(Max WT)for ACI presence in ICAs were good in T2DM group and without statistically significant difference for both corhorts.In addition,in patients with plaques,independent of luminal stenosis and other significant factors,positive correlations were observed between LRNC%and ACI volumes in T2DM patients(b = 0.529,P <0.001),while no correlations was observed between plaque characteristic and ACI volumes in non T2DM patients.Conclusions Carotid plaque vulnerable feature especially large LRNC%are closely related to ACI presence in ICAs as well as the ACI volumes in T2DM patients suffering rencent stroke.