P702Diagnostic and prognostic micro-RNAs in ischemic stroke due to carotid artery stenosis and in acute coronary syndrome: the 4-year prospective study

Background: Carotid artery stenosis is one of the major causes of ischemic strokes. However, degree of stenosis is not always correlated with frequency of ischemic strokes. Recently, it was reported that carotid intraplaque hemorrhage (IPH) was associated with accelerated plaque growth, luminal narrowing and development of symptomatic events. Maximum intensity projection (MIP) images are easily reformatted within from 5 minute, routine time-of-flight (TOF) sequences. The aim of this study was to evaluate the relationships between high intensity signal (HIS) in the carotid plaques on MIP images detected by routine three-dimensional TOF magnetic resonance angiography (3D-TOF MRA) and ischemic strokes. Materials and Methods: One hundred fifty two patients with low-grade carotid artery stenosis (North American Symptomatic Carotid Endarterectomy Trial criteria: 30% - 49%) were included. IPH was defined as the presence of HIS in the carotid plaques on MIP images of 3D-TOF MRA using the previously reported criteria. We analyzed the relationship between the presence of HIS in the plaques and prior ischemic strokes defined as ischemic lesions on diffusion weighed images of the brain. Results: HIS in the carotid plaque was present in 56 (37%) of 152 carotid arteries. Prior ipsilateral ischemic strokes were observed more frequently in HIS-positive group (12 of 56, 21.4%) than HIS-negative group (1 of 34: 2.9%) [p<0.001]. In multivariate logistic regression analysis, HIS (Odds ratio: 77.7, 95%CI: 6.4 - 944.0, p<0.001) and diabetes mellitus type 2 (odds ratio: 10.45, 95%CI: 1.6 - 67.9, p=0.014) were independent determinants of prior ischemic strokes after adjustment for age. Conclusions: HIS in the carotid plaques on MIP images of 3D-TOF MRA was an independent determinant of prior ischemic stroke in patients with low-grade carotid artery stenosis, and this finding may provide a reliable risk stratification of future stroke in patients with low-grade carotid artery stenosis.

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Abstract 2352: 18F-fluorodeoxyglucose PET Can Identify The Inflamed and Vulnerable Carotid Plaque - A Prospective Study in Japan

Stroke ◽

10.1161/str.43.suppl_1.a2352 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Satoshi Kuroda ◽

Hisayasu Saito ◽

Katsuhiko Maruichi ◽

Naoki Nakayama ◽

Kenji Hirata ◽

...

Keyword(s):

Carotid Artery ◽

Prospective Study ◽

Carotid Artery Stenosis ◽

Fdg Pet ◽

Vulnerable Plaque ◽

Japanese Patients ◽

Artery Stenosis ◽

Fdg Uptake ◽

Standardized Uptake Values ◽

18F Fdg

Objective - There are few studies that denote the validity of 8F-fluorodeoxyglucose (FDG) PET to detect the inflammation of severe (>70%) carotid artery stenosis in Asian populations. This study was aimed to clarify whether 18F-FDG PET can identify inflamed and vulnerable plaque at higher risk for subsequent ischemic stroke in Japanese patients with severe carotid artery stenosis. Methods - This prospective study included 33 patients with severe carotid artery stenosis between 2006 and 2011. Of these, 12 patients were symptomatic and other 21 were asymptomatic. There were 28 males and 5 females. Their mean age was 71.1 ± 8.2 years, ranging from 48 to 85. Their clinical data were precisely collected. All 33 patients underwent 18F-FDG PET and ultrasound sonography (US) to evaluate the plaque composition prior to carotid endarterectomy (CEA). FDG uptake was quantified by maximum standardized uptake values (SUV). Following surgery, the specimens were stained with the antibodies against CD68 and MMP-9. Results - High FDG uptake (SUV>2.0) was observed in 15 (45%) of 33 operated plaques. High FDG uptake significantly correlated with the other vascular disorders (P=0.048), echolucent plaque (P=0.041), lipid-rich plaque (P<0.001), CD68 expression (P<0.001), and MMP-9 expression (P=0.002). 18F-FDG PET showed significantly higher sensitivity and specificity to identify lipid-rich and CD68-positive plaque than US. However, high FDG uptake was not related to patients’ gender, age, and the degree of stenosis. There was no significant correlation between FDG uptake and symptomatic or asymptomatic patients. Conclusion - These findings strongly suggest that 18F-FDG PET would provide more valuable information to identify the inflamed, vulnerable plaque than conventional ultrasound in Japanese patients with severe carotid artery stenosis.

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