Detection of Symptomatic Carotid Plaque Using Source Data from MR and CT Angiography: A Correlative Study

Background: Carotid plaque MRI has been a useful method to characterize vulnerable atherosclerotic plaque elements. Recent investigations have suggested that source images from CT angiography (CTA) and MR angiography (MRA) can identify the simple high-risk features of symptom-producing carotid artery plaque. We studied the correlation and relative diagnostic accuracies of CTA and MRA source images in detecting symptomatic carotid artery plaque. Methods: Subjects were eligible if they had carotid stenosis between 50 and 99% and had MRA and CTA exams performed within 10 days of one another. We measured the soft (non-calcified) plaque and hard (calcified) plaque thickness on CTA axial source images and intraplaque high-intensity signal (IHIS) on 3D-time-of-flight MRA source images in subjects. We assessed whether a correlation existed between increasing CTA soft plaque thicknesses and the presence of MRA IHIS using the Student's t-test. We calculated the differences in sensitivity and specificity measures of CTA and MRA source-imaging data with the occurrence of recent ipsilateral stroke or transient ischemic attack (TIA) as the reference standard. We also performed logistic regression analyses to evaluate the predictive strength of plaque showing both IHIS and increased CTA soft plaque thickness in predicting symptomatic disease status. Results: Of 1994 screened patients, 48 arteries met the final inclusion criteria with MRA and CTA performed within 10 days of one another. The mean and median time between CTA and MRA exams were 2.0 days and 1 day, respectively. A total of 34 of 48 stenotic vessels (70.8%) were responsible for giving rise to ipsilateral stroke or TIA. CTA mean soft plaque thickness was significantly greater (4.47 vs. 2.30 mm, p < 0.0001) in patients with MRA-defined IHIS, while CTA hard plaque thickness was significantly greater (2.09 vs. 1.16 mm, p = 0.0134) in patients without MRA evidence of IHIS. CTA soft plaque thickness measurements were more sensitive than MRA IHIS (91.2 vs. 67.6%, p = 0.011) in detecting symptomatic plaque, while differences in specificity were not significantly different (p = 0.1573). In the subset of patients with both IHIS on MRA and plaque thickness >2.4 mm on CTA, the odds ratio of detecting symptomatic plaque, corrected for stenosis severity, was 45.3 (p < 0.0005). Conclusions: Unprocessed source images from CTA and MRA, which are routinely evaluated for clinical studies demonstrate the highly correlated presence of IHIS and increasing soft plaque thickness. In particular, plaque that shows high-risk features on both MRA and CTA are very strongly associated with symptom-producing carotid plaque. With further validation, such techniques are promising practical methods of extracting risk information from routine neck angiographic imaging.

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Plaque morphology (the PLAC Scale) on CT angiography: predicting long-term anatomical success of primary carotid stenting

Journal of Neurosurgery ◽

10.3171/2014.9.jns14811 ◽

2015 ◽

Vol 123 (4) ◽

pp. 856-861 ◽

Cited By ~ 12

Author(s):

David M. Pelz ◽

Stephen P. Lownie ◽

Donald H. Lee ◽

Melfort R. Boulton

Keyword(s):

Carotid Artery ◽

Ct Angiography ◽

Carotid Plaque ◽

Peak Systolic Velocity ◽

Carotid Stenting ◽

Plaque Morphology ◽

Term Outcome ◽

Long Term Outcome ◽

Soft Plaque

OBJECT Carotid angioplasty and stenting has emerged as an alternative to carotid endarterectomy for the treatment of atherosclerotic carotid stenosis. Primary carotid stenting, performed using self-expanding stents alone without deliberate use of embolic protection devices and balloon angioplasty, has been shown to be effective and faster, cheaper, and potentially safer than conventional techniques. However, the long-term morphological results of this technique have not been established. The aim of this study was to determine whether preprocedural carotid plaque imaging at the site of maximal stenosis by using CT angiography (CTA) could predict the long-term morphological outcome of primary carotid stenting. METHODS One hundred eighty-one patients were treated over an 11-year period. Preprocedural CTA was performed in 102 of these. A morphological scale (the Predicting Long-term outcome with Angioplasty of the Carotid artery [PLAC] Scale), with grades from 0 to 4 and A or B, was used to evaluate the circumferential degree of plaque calcification, and the presence or absence of soft plaque. All patients were followed using duplex carotid ultrasound and plain radiographs. Satisfactory morphological outcome was defined as a peak systolic velocity < 120 cm/s and internal carotid artery/common carotid artery ratio < 1.4. RESULTS The average follow-up duration was 29.7 months (median 24.5 months, range 0.3–87 months). Univariate logistic regression demonstrated that a low calcification grade (p < 0.001), less thick calcification (p < 0.001), and moderate amounts of soft plaque (p < 0.001) are factors that are highly associated with good long-term outcome. Multivariate analyses confirmed that these factors are independent of each other in predicting outcome. CONCLUSIONS The long-term morphological outcome of primary carotid stenting was predicted with considerable accuracy by using a straightforward CTA carotid plaque grading scale.

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P4389Effect of cigarette smoking on carotid artery atherosclerosis: a community-based cohort study

European Heart Journal ◽

10.1093/eurheartj/ehz745.0794 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

H Kiriyama ◽

H Kaneko ◽

H Itoh ◽

Y Yoshida ◽

K Nakanishi ◽

...

Keyword(s):

Cardiovascular Diseases ◽

High Risk ◽

Carotid Artery ◽

Cigarette Smoking ◽

Carotid Plaque ◽

Subclinical Atherosclerosis ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Carotid Artery Plaque ◽

Never Smokers

Abstract Background Cigarette smoking is closely associated with the development of cardiovascular diseases (CVD), and the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines recommend smoking bans.On the other hand, the relationship between cigarette smoking and subclinical atherosclerosis has not been fully studied. Carotid intima-media thickness (cIMT) is commonly used as a subclinical atherosclerosis marker, and a carotid plaque feature is also known to be an important predictor of cardiovascular diseases. Purpose We sought to clarify the association between cigarette smoking and subclinical atherosclerosis by evaluating carotid plaque including cIMT and carotid plaque features in general population. Methods and results Among 1,209 participants with no prior coronary artery disease who received a medical check-up with cardiovascular examination at our institution, 450 participants (37.2%) were smokers (including both past and current smokers). We defined carotid plaque as cIMT ≥1.1 mm and high-risk plaque as carotid plaque with hypoechoic dominant and/or plaque ulceration. The value of cIMT and the rate of carotid plaque were not different between smokers and never smokers (Figure A & B). However, the rate of carotid high-risk plaque was significantly higher in participants with smokers than those with never smokers (29.7%, vs 23.5%, p=0.011) (Figure C). Even after adjustment with covariates including age, gender and traditional cardiovascular risk factors, cigarette smoking was independently associated with high-risk plaque formation (odds ratio 1.384, 95% CI 1.020–1.877; p=0.037). According to the subgroup analysis classified by age, cigarette smoking was associated with not only the development of high-risk plaque but also the increased value of cIMT in the subgroup over 60 years old, whereas only the rate of high-risk plaque was higher in smokers than never smokers in the subgroup under 60 years old. Carotid plaque and smoking Conclusion The development of high-risk carotid artery plaque may precede thickening of cIMT in cigarette smokers, suggesting that the novel insight for the pathological mechanism underlying cardiovascular events and cigarette smoking.

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Imaging of high-risk carotid artery plaques: current status and future directions

Neurosurgical FOCUS ◽

10.3171/2013.10.focus13384 ◽

2014 ◽

Vol 36 (1) ◽

pp. E1 ◽

Cited By ~ 15

Author(s):

J. Kevin DeMarco ◽

John Huston

Keyword(s):

High Risk ◽

Carotid Artery ◽

Carotid Plaque ◽

Treatment Strategies ◽

Automated Analysis ◽

Current Status ◽

Intraplaque Hemorrhage ◽

Carotid Artery Plaque ◽

Future Directions

In this paper, the authors review the definition of high-risk plaque as developed by experienced researchers in atherosclerosis, including pathologists, clinicians, molecular biologists, and imaging scientists. Current concepts of vulnerable plaque are based on histological studies of coronary and carotid artery plaque as well as natural history studies and include the presence of a lipid-rich necrotic core with an overlying thin fibrous cap, plaque inflammation, fissured plaque, and intraplaque hemorrhage. The extension of these histologically identified high-risk carotid plaque features to human in vivo MRI is reviewed as well. The authors also assess the ability of in vivo MRI to depict these vulnerable carotid plaque features. Next, the ability of these MRI-demonstrated high-risk carotid plaque features to predict the risk of ipsilateral carotid thromboembolic events is reviewed and compared with the risk assessment provided by simple carotid artery stenosis measurements. Lastly, future directions of high-risk carotid plaque MRI are discussed, including the potential for increased clinical availability and more automated analysis of carotid plaque MRI. The ultimate goal of high-risk plaque imaging is to design and run future multicenter trials using carotid plaque MRI to guide individual patient selection and decisions about optimal atherosclerotic treatment strategies.

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Evaluation of Carotid Plaque Composition by Computed Tomography Angiography and Black Blood Magnetic Resonance Image

Interventional Neuroradiology ◽

10.1177/159101990801400105 ◽

2008 ◽

Vol 14 (1) ◽

pp. 39-43 ◽

Cited By ~ 3

Author(s):

K. Haraguchi ◽

K. Houkin ◽

I. Koyanagi ◽

T. Nonaka ◽

T. Baba

Keyword(s):

Computed Tomography ◽

Magnetic Resonance ◽

Carotid Artery ◽

Ct Angiography ◽

Carotid Plaque ◽

High Reliability ◽

Black Blood ◽

Ct Number ◽

Carotid Artery Plaque ◽

Black Blood Mri

The purpose of this study was to evaluate the composition of a carotid plaque quantitatively by computed tomography (CT) angiography and qualitatively by black blood magnetic resonance imaging (MRI). Thirty-eight patients with high-grade carotid artery stenosis were included in this study. Ultrasonography, CT angiography and black blood MRI of the cervical carotid artery were performed, and the CT number was measured in Hounsfield units (HU). The average CT number of the 15 unstable plaques (39.5%) was 27.7 ± 7.5 HU and that of the 23 stable plaques (60.5%) was 60.4 ± 20.8 HU (p <0.0001). In the 23 patients with stable plaque, 21 demonstrated isointensity in T1 and T2 in the black blood MRI (p <0.0001). By using CT angiography and MRI, precise images of the pathology of the carotid arterial wall can be obtained. It is possible to evaluate the components of a carotid artery plaque with high reliability by quantification of the CT number in CT angiography and performing black blood MRI as well as in carotid ultrasonography.

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Association of plaque echostructure and cardiovascular risk factors with symptomatic carotid artery disease

VASA ◽

10.1024/0301-1526.38.4.357 ◽

2009 ◽

Vol 38 (4) ◽

pp. 357-364 ◽

Cited By ~ 5

Author(s):

Giannoukas ◽

Sfyroeras ◽

Griffin ◽

Saleptsis ◽

Antoniou ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Carotid Artery ◽

Cardiovascular Risk Factors ◽

Carotid Plaque ◽

Young Patients ◽

Symptomatic Disease ◽

Age Related ◽

Ica Stenosis

Background: Severity of stenosis remains the main factor for assessing risk of stroke in patients with internal carotid artery (ICA) disease. This study was conducted to investigate the association of plaque echostructure and other established and emerging cardiovascular risk factors with symptomatic ICA disease. Design: Cross-sectional study of consecutive patients with significant (> 50 %) ICA stenosis. Patients and methods: Carotid plaque echostructure, smoking, hypertension, diabetes mellitus, serum lipoprotein (a), homocysteine, vitamin B12, folate, cholesterol to high-density lipoprotein ratio, triglycerides, C-reactive protein, and the Framingham risk score were assessed in 124 consecutive patients (70 asymptomatic; 54 symptomatic) with significant (> 50 %) ICA stenosis. Results: The asymptomatic and symptomatic groups did not differ in terms of gender distribution (p = 0.76) and severity of stenosis (p = 0.62). Echolucent plaques (type 1 and 2) were more predominant in patients with symptomatic disease (p = 0.004, OR = 2.13, 95 % CI = 1.26-3.6). Patients with plaques type 1 were relatively younger than those with type 4 (p = 0.02). None of the other factors assessed had any significant association with symptomatic disease and any type of carotid plaque. Conclusions: Besides the severity of carotid stenosis, the presence of an echolucent plaque appears as an important factor associated with symptomatic ICA disease. Also, young patients are more likely to have an echolucent plaque suggesting an age-related association with plaque maturation.

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Diagnostic accuracy of dual-source CT angiography for evaluation of coronary artery and comparative analysis of the DSCT angiography of the internal carotid artery plaque with the histopathological specimens

Comparative Clinical Pathology ◽

10.1007/s00580-015-2129-5 ◽

2015 ◽

Vol 25 (1) ◽

pp. 7-14 ◽

Cited By ~ 1

Author(s):

Babak Shekarchi ◽

Marzieh Motevalli ◽

Ali Mohammadzadeh ◽

Morteza Noormohammadzadeh

Keyword(s):

Comparative Analysis ◽

Coronary Artery ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Diagnostic Accuracy ◽

Ct Angiography ◽

Internal Carotid ◽

Dual Source Ct ◽

Carotid Artery Plaque ◽

Dual Source

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Abstract P322: Association of Hiv Infection With Carotid Artery Plaque Echomorphology in the Women’s Interagency HIV Study (wihs)

Circulation ◽

10.1161/circ.141.suppl_1.p322 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Claudio A Bravo ◽

Jee-Young Moon ◽

Jean Claude Uwamungu ◽

Robert Kaplan ◽

Kathryn Anastos ◽

...

Keyword(s):

Cardiovascular Disease ◽

Carotid Artery ◽

Hiv Infection ◽

Carotid Plaque ◽

Cd4 Count ◽

Morbidity And Mortality ◽

Hiv Care ◽

Carotid Artery Plaque ◽

Hiv Women ◽

Hiv Negative

Introduction: Cardiovascular disease is a major contributor to morbidity and mortality among women living with HIV (WLWH). We previously found HIV infection to be associated with carotid artery plaque, a marker of subclinical atherosclerosis. Plaque morphology and composition may predict plaque rupture and cardiovascular disease events. We characterized the association of HIV-related factors with carotid plaque echomorphology in the WIHS. Methods: Using B-mode ultrasound, we characterized plaque (focal intima-media thickness >1.5 mm) at 6 locations in the right carotid artery in 1,722 participants (1,230 HIV+, 492 HIV-) of the WIHS, a cohort study of women with or at risk for HIV at 6 US sites. Plaque echomorphologic features included relative echogenicity (>50% of plaque is echolucent vs >50% of plaque is echogenic) and surface morphology (smooth vs irregular, i.e., height variations along contour of plaque). We used multinomial logistic regression to assess the odds of each feature vs no plaque comparing HIV+ and HIV- women, adjusting for demographic (e.g., age, race/ethnicity, socioeconomic status), behavioral (e.g., drug/alcohol use, smoking, HCV infection, smoking), cardiometabolic (e.g., systolic blood pressure, BMI, lipids, diabetes) and HIV-related risk factors (e.g., antiretroviral therapy use, current CD4+ T-cell count, AIDS). We further stratified WLWH by CD4+ count (<200, 200-499, 500+ cells/uL) and HIV-1 RNA suppression. Results: Among 1,722 women (median age 40, IQR 33-46, 59% black, 29% Hispanic, 71% HIV+), 160 (9%) had at least one carotid plaque (128 HIV+, 32 HIV-). In unadjusted analyses, WLWH had more echolucent plaque (5.3% vs 2.6%, p=0.02) and plaques with smooth surface (2.7% vs 0.6%, p=0.005) than HIV-negative women. After covariate adjustment, HIV serostatus remained significantly associated with smooth plaque (odds ratio [OR] 3.45, 95% CI 1.12-10.62) but not with echolucent plaque (OR 1.60, 95% CI 0.84-3.05). Stratified by HIV viremia, WLWH with unsuppressed HIV viremia had significantly more smooth plaque (OR 3.34, 95% CI 1.26-8.87) than HIV- women, whereas suppressed WLWH did not (OR 1.79, 95% CI 0.55-5.83). In a dose-response manner, lower CD4+ count among WLWH was associated with smooth plaque (e.g., OR for <200 cells/uL compared with HIV-negative women 7.43, 95% CI 1.46-37.87), and this association was of greater magnitude than that with irregular plaque (OR 2.46, 95% CI 1.14-5.32). Low CD4+ count was also associated with both echolucent (OR 3.36 for <200 cells/uL vs HIV-negative, 95% CI 1.29-8.77) and echogenic plaque (OR 2.65, 95% CI 1.18-5.96). Conclusions: Unsuppressed viremia and low CD4+ count, which are markers of suboptimal HIV care, were associated with certain echomorphologic features of carotid plaque. Further work should assess whether these features differentially lead to cardiovascular morbidity and mortality in WLWH.

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170 Vasa Vasorum Activities in Human Carotid Atherosclerosis is Associated with Plaque Development and Vulnerability

Neurosurgery ◽

10.1093/neuros/nyx417.170 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 243-244

Author(s):

Sungpil Joo

Keyword(s):

T Cell ◽

Mast Cells ◽

Carotid Artery ◽

Carotid Plaque ◽

Vasa Vasorum ◽

Plaque Vulnerability ◽

Unstable Plaque ◽

Symptomatic Carotid ◽

Before And After ◽

Stable Plaque

Abstract INTRODUCTION Carotid endarterectomy (CEA) has been shown to be beneficial in patients with high-grade symptomatic carotid artery stenosis. Subintimal and intraplaque hemorrhages are frequently seen during CEA in the absence of any visible breach in the intima, as these changes are derived from the vasa vasorum system rather than from blood in the vessel lumen. Imaging modalities to characterize unstable, vulnerable plaques are strongly needed for better risk stratification in these patients. The aim of this study was to investigate the correlation between the activities of the carotid vasa vasorum and carotid plaque vulnerability using indocyanine green-video angiography (ICG-VA) during CEA, focusing on how the carotid artery vasa vasorum is depicted. METHODS Sixty-nine patients (mean age, 68.5 ± 2.5 years; mean degree of stenosis, 78.9 ± 3.8) who underwent CEA were enrolled prospectively from September 2013 to December 2014. ICG was injected intravenously as a bolus before and after resecting the atheroma during CEA. We also performed immunohistochemistry using CD68 (macrophage), CD117 (mast cell), CD4 (T-cell), and CD8 (T-cell) antibodies for resected plaque specimens. RESULTS >Active vasa vasorum density was observed in all patients on ICG-VA (n = 69). The vasa vasorum externa (VVE) and interna (VVI) were seen in 11 (16%) and 57 patients (82.6%), respectively. The types of VVE were strongly associated with preoperative angiographic instability (90.0%, P = 0.005) and carotid plaque vulnerability (100%, P = 0.007) macroscopically. In contrast, the types of VVI were less associated with angiographic instability (36.1%) and plaque vulnerability (49.1%, P = 0.003). CD86- and CD117-stained macrophages and mast cells were observed more frequently in unstable plaque, compared to those in stable plaque (P < 0.0001, P = 0.002, respectively). CONCLUSION The early appearance of VVE on ICG-VA was strongly associated with unstable carotid plaque and many microvessel channels that provided nutrients to the developing and expanding intima and potentially created an unstable hemorrhagic environment prone to rupture. Macrophages and mast cells were involved in the formation of microvessels in the atherogenic plaque and accelerated plaque progression into an unstable plaque phenotype.

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