High-Intensity Signal in Carotid Plaque on Routine 3D-TOF-MRA Is a Risk Factor of Ischemic Stroke

2015 ◽  
Vol 41 (1-2) ◽  
pp. 13-18 ◽  
Author(s):  
Kiyofumi Yamada ◽  
Masanori Kawasaki ◽  
Shinichi Yoshimura ◽  
Manabu Shirakawa ◽  
Kazutaka Uchida ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Plaque ◽  
Artery Stenosis ◽  
Carotid Plaques ◽  
Tof Mra ◽  
The Relationship ◽  
Ischemic Events

Background: Carotid atherosclerotic disease is recognized as an important risk factor for brain ischemic events. However, high-grade stenosis does not always cause ischemic strokes, whereas moderate-grade stenosis may often cause ischemic strokes. It has been reported that there is an association between carotid intraplaque hemorrhage (IPH) and new cerebral ischemic events. The purpose of this study was to elucidate the relationship between high-intensity signals (HIS) on maximum intensity projection (MIP) images from routine 3-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) and prior ischemic strokes in the patients with moderate carotid stenosis. Materials and Methods: Sixty-one patients with moderate carotid artery stenosis (50-69% stenosis based on North American Symptomatic Carotid Endarterectomy Trial criteria) were included. Carotid IPH was defined as the presence of HIS in carotid plaques on MIP images detected by 3D-TOF-MRA using criteria we previously reported. We analyzed the relationship between the presence of HIS in plaques and prior ischemic strokes defined as ischemic lesions on diffusion-weighted brain images. Results: HIS in carotid plaques were present in 27 (44%) of 61 patients. Prior ipsilateral ischemic strokes occurred more frequently in the HIS-positive group than the HIS-negative group (67 vs. 9%, p < 0.001). Furthermore, there were more smokers in the group with ischemic stroke than without it (62 vs. 25%, p = 0.005). In multivariate logistic regression analysis, HIS in carotid plaque (OR 23.4, 95% CI 4.62-118.3, p < 0.001) and smoking (OR 5.44, 95% CI 1.20-24.6, p = 0.028) were independent determinants of prior ischemic strokes after adjustment for age. Conclusions: HIS in carotid plaques on 3D-TOF-MRA MIP images are independent determinants of prior ischemic strokes in patients with moderate carotid artery stenosis, and they can potentially provide a reliable risk stratification of patients with moderate carotid artery stenosis.

Abstract TMP33: High Intensity Signal in the Plaque on 3DTOF MRA is Associated With Ischemic Stroke in the Patients With Low Grade Carotid Artery Stenosis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kiyofumi Yamada ◽  
Masanori Kawasaki ◽  
Shigehiro Nakahara ◽  
Yoshikazu Sato ◽  
Kazutaka Uchida ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
High Intensity ◽  
Odds Ratio ◽  
Artery Stenosis ◽  
Low Grade ◽  
Carotid Plaques ◽  
Tof Mra ◽  
High Intensity Signal

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.

scholarly journals CAROTID ARTERY STENOSIS AS A RISK FACTOR FOR THE OCCURRENCE OF ISCHEMIC STROKE

2016 ◽  
Vol 55 (2) ◽  
pp. 40-45
Author(s):  
Biljana Živadinović ◽  
◽  
Dragan Stojanov ◽  
Srđan Ljubisavljević ◽  
Jelena Stamenović ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis

Abstract WP122: Asymptomatic Moderate Carotid Artery Stenosis With Intraplaque Hemorrhage ∼ Progression of Degree of Stenosis and New Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Kiyofumi Yamada ◽  
Masanori Kawasaki ◽  
Shinichi Yoshimura ◽  
Shigehiro Nakahara ◽  
Yoshikazu Sato
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Carotid Plaque ◽  
Intraplaque Hemorrhage ◽  
Progression Rate ◽  
Negative Group ◽  
Positive Group ◽  
Carotid Plaques

Background: Carotid artery stenosis is one of the major causes of ischemic stroke. Carotid intraplaque hemorrhage (IPH) plays a critical role in the progression of carotid atherosclerotic disease. Previous studies showed that IPH was associated with high intensity signal (HIS) on maximum intensity projection (MIP) images from routine three dimensional magnetic resonance imaging (3D-TOF MRA). The aim of this study was to evaluate the relationships among HIS, new ipsilateral ischemic stroke and a progression rate in carotid plaques with moderate stenosis. Materials and Methods: We included 45 carotid plaques with moderate stenosis (50% to 69%) in 45 patients who could be followed more than 12 months. Carotid IPH was defined as the presence of HIS in carotid plaque on MIP image from routine 3DTOF MRA using the criteria previously we published. We analyzed the relation between the presence of HIS in the plaques and new ischemic strokes and annual progression rate of carotid stenosis. Results: HIS in carotid plaque was present in 21 (47%) carotid arteries. Over a follow-up period of 24 ± 9 months, six ischemic strokes occurred ipsilateral to the index carotid artery. New ipsilateral ischemic stroke occurred more frequently in HIS positive group (6 of 21, 29%) than HIS negative group (0 of 24, 0%) (p=0.017). Annual progression rate of carotid stenosis is significantly higher in HIS positive group (+3.35%/year) than HIS negative group (-0.02%/year) (p= 0.0026). In multivariate regression analysis, HIS positive was an independent predictor for annual progression rate of carotid stenosis (p=0.003). Conclusions: HIS in carotid plaques on 3DTOF-MRA MIP images are associated with new ischemic stroke and higher annual progression rate of stenosis. Evaluation of HIS in asymptomatic moderate carotid stenosis can potentially provide risk stratification of new ipsilateral ischemic strokes.

Ultrasound Characteristics of Symptomatic Carotid Plaques: A Systematic Review and Meta-Analysis

2015 ◽  
Vol 40 (3-4) ◽  
pp. 165-174 ◽  
Author(s):  
Waleed Brinjikji ◽  
Alejandro A. Rabinstein ◽  
Giuseppe Lanzino ◽  
Mohammad H. Murad ◽  
Eric E. Williamson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Publication Bias ◽  
Carotid Artery Stenosis ◽  
Meta Analysis ◽  
Artery Stenosis ◽  
Surface Irregularity ◽  
Asymptomatic Carotid ◽  
Carotid Plaques

Background: Ultrasound is the most commonly used imaging modality for assessing carotid artery stenosis. A number of studies have demonstrated that surface irregularities, heterogeneous echotexture and hypoechoic plaques are risk factors for acute ischemic stroke. We performed a systematic review and meta-analysis of the literature to better define the risk of stroke based on the sonographic characteristics of carotid plaques. Materials and Methods: We performed a comprehensive search for studies reporting imaging findings of symptomatic and asymptomatic carotid plaques on ultrasound using MEDLINE and EMBASE. We included both case-control and cohort studies examining the relationship between complex plaque and acute ischemic stroke or transient ischemic attack. Complex plaque was defined as plaque that had any of the following characteristics: heterogeneous echogenicity, echolucency, neovascularization, surface irregularity, ulceration, and intraplaque motion. Meta-analyses using the random-effects model were performed for complex plaque and each of the individual complex plaque characteristics. p < 0.05 was considered statistically significant. We explored the impact of publication bias by constructing funnel plots and testing their symmetry. We conducted the meta-analysis using Comprehensive Meta-analysis version 2.2, Englewood, N.J., USA. Results: A total of 1,013 articles were screened and 23 studies with 6,706 carotid plaques were included. Ultrasound plaque characteristics with a higher prevalence in individuals with symptomatic compared to asymptomatic carotid artery stenosis included plaque neovascularity (OR = 19.68, 95% CI = 3.14-123.16), complex plaque (OR = 5.12, 95% CI = 3.42-7.67), plaque ulceration (OR = 3.58, 95% CI = 1.66-7.71), plaque echolucency (OR = 3.99, 95% CI = 3.06-5.19) and intraplaque motion (OR = 1.57, 95% CI = 1.02-2.41). Variables not associated with symptom status included heterogenous echotexture (OR = 2.68, 95% CI = 0.56-12.80) and surface irregularity without ulceration (OR = 2.38, 95% CI = 0.70-8.11). No evidence of publication bias was observed based on Eggers test (p value of 0.05 for complex plaque and 0.53 for plaque echolucency). The remaining plaque features had insufficient data to assess for publication bias. Conclusions: Our meta-analysis and systematic review of the literature demonstrated that plaques with complex features, particularly those with echolucency, neovascularization, ulceration and intraplaque motion are associated with ischemic symptoms. Assessment of carotid plaque on ultrasound may provide stroke risk information beyond measurement of luminal stenosis. Thus, sonographic evaluation of carotid artery stenosis should focus on the detection of these plaque characteristics in addition to quantifying the degree of stenosis.

scholarly journals Plaque Length Predicts the Incidence of Microembolic Signals in Acute Anterior Circulation Stroke

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Liming Zhao ◽  
Hongqin Zhao ◽  
Yicheng Xu ◽  
Aijuan Zhang ◽  
Jiatang Zhang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Plaque ◽  
Intima Media Thickness ◽  
Roc Curves ◽  
Cross Sectional Study ◽  
Artery Stenosis ◽  
Anterior Circulation ◽  
Cross Sectional ◽  
The Relationship

Microembolic signals (MES) of the carotid artery are associated with plaque destabilization and reoccurrence of stroke. Previous studies have focused primarily on the degree of carotid artery stenosis and plaque components, and the relationship between plaque length and microembolic sign has received little attention. We aimed to find the association between carotid plaque length (CPL) and the presence of MES. We conducted a retrospective observational cross-sectional study. A total of 84 acute anterior-circulation ischemic stroke/transient ischemic attack (TIA) patients with carotid artery atherosclerosis were classified into an MES-positive (MES+) group and MES-negative (MES−) group. We measured multiple parameters of carotid plaque size (length, thickness) in each patient and evaluated the relationship between different plaque parameters and occurrence of MES. We found that male, carotid artery stenosis (CAS), CPL, carotid plaque thickness (CPT), and intima-media thickness (IMT) of the carotid artery were each significantly different between two groups (all P < 0.05 ). The multivariate analysis showed CPL (odds ratio (OR), 1.109; 95% CI, 1.044–1.177; P = 0.001 ) to be independently associated with the presence of MES. The areas under the ROC curves (AUCs) for CPL for predicting MES were 0.777 (95% CI, 0.640–0.914; P < 0.001 ). The cutoff value of CPL for predicting MES was 16.7 mm, with a sensitivity of 88.2% and a specificity of 77.6%. We found that CPL was a meaningful independent predictor of MES. Therefore, CPL may be useful for risk stratification of long and nonstenotic plaques in anterior circulation stroke.

scholarly journals A study on prevalence of carotid artery stenosis in acute ischaemic stroke patients in Amalapuram, Andhra Pradesh, India

2019 ◽  
Vol 7 (6) ◽  
pp. 2146
Author(s):  
Bonthu Mamatha Bharathi ◽  
Raveena Gullapalli
Keyword(s):  
Risk Factor ◽  
Carotid Artery ◽  
Ischaemic Stroke ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Acute Onset ◽  
Artery Stenosis ◽  
Doppler Study ◽  
Diastolic Velocity ◽  
Asymptomatic Patients

Background: Extra cranial carotid disease due to arteriosclerosis is usually associated with hypercholesterolemia and hyperlipidemia. Extra cranial carotid stenosis has been found to be less prevalent in black American and in Egyptians while intracranial disease is far more common Various methods includes transcranial doppler (TCD) ultrasonography, cerebral angiography, computed tomography angiography (CTA) and magnetic resonance angiography (MRA).Methods: All patients with ischaemic stroke of acute onset admitted in the medical wards of Konaseema institute of medical sciences between June 2018 and January 2019 were included in the study. All patients were subjected to CT scan brain study and colour Doppler study of extra cranial carotid arteries and vertebral arteries. Systolic and diastolic velocity of blood flow, carotid intimal medial thickness, presence of athermanous plaque and thrombus was looked for and then the percentage of stenosis of the affected arteries was calculated.Results: In the present study 0ut of 23 patients with carotid stenosis 9 patients had mild carotid stenosis, 8 patients had moderate stenosis and 6 patients had severe stenosis. Out of 23 patients with carotid stenosis the 11 patients have stenosis in the right carotid and 12 patients had stenosis in the left side. The site of stenosis is ICA in 17 patients and CCA in 6 patients.Conclusions: In present study every patient with carotid artery stenosis had one or the other risk factor for carotid atherosclerosis. In other words, there was no patient with carotid artery stenosis, without any risk factor in present study. Hence asymptomatic patients with these risk factors should be screened for carotid stenosis to prevent stroke.

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