Magnetic Resonance Imaging Plaque Hemorrhage for Risk Stratification in Carotid Artery Disease With Moderate Risk Under Current Medical Therapy

Background Comprehensive hemodynamic impairment mapping using blood oxygenation‐level dependent (BOLD) cerebrovascular reactivity (CVR) can be used to identify hemodynamically relevant symptomatic unilateral carotid artery disease. Methods and Results This prospective cohort study was conducted between February 2015 and July 2020 at the Clinical Neuroscience Center of the University Hospital Zurich, Zurich, Switzerland. One hundred two patients with newly diagnosed symptomatic unilateral internal carotid artery (ICA) occlusion or with 70% to 99% ICA stenosis were included. An age‐matched healthy cohort of 12 subjects underwent an identical BOLD functional magnetic resonance imaging examination. Using BOLD functional magnetic resonance imaging with a standardized CO 2 stimulus, CVR impairment was evaluated. Moreover, embolic versus hemodynamic ischemic patterns were evaluated on diffusion‐weighted imaging. Sixty‐seven patients had unilateral ICA occlusion and 35 patients unilateral 70% to 99% ICA stenosis. Patients with ICA occlusion exhibited lower whole‐brain and ipsilateral hemisphere mean BOLD‐CVR values as compared with healthy subjects (0.12±0.08 versus 0.19±0.04, P =0.004 and 0.09±0.09 versus 0.18±0.04, P <0.001) and ICA stenosis cohort (0.12±0.08 versus 0.16±0.05, P =0.01 and 0.09±0.09 versus 0.15±0.05, P =0.01); however, only 40 (58%) patients of the cohort showed significant BOLD‐CVR impairment. Conversely, there was no difference in mean BOLD‐CVR values between healthy patients and patients with ICA stenosis, although 5 (14%) patients with ICA stenosis showed a significant BOLD‐CVR impairment. No significant BOLD‐CVR difference was discernible between patients with hemodynamic ischemic infarcts versus those with embolic infarct distribution (0.11±0.08 versus 0.13±0.06, P =0.12). Conclusions Comprehensive BOLD‐CVR mapping allows for identification of hemodynamically relevant symptomatic unilateral carotid artery stenosis or occlusion.

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MS537 IMPACT OF PLAQUE HAEMORRHAGE ON PLAQUE STRESS IN PATIENTS WITH CAROTID ARTERY DISEASE – A PATIENT-SPECIFIC MAGNETIC RESONANCE IMAGING STUDY

Atherosclerosis Supplements ◽

10.1016/s1567-5688(10)71037-0 ◽

2010 ◽

Vol 11 (2) ◽

pp. 218

Author(s):

U. Sadat ◽

Z. Teng ◽

V. Young ◽

J. Gillard

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Carotid Artery ◽

Carotid Artery Disease ◽

Imaging Study ◽

Patient Specific ◽

Magnetic Resonance Imaging Study ◽

Resonance Imaging ◽

Artery Disease

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Development of Molecular Magnetic Resonance Imaging Tools for Risk Stratification of Carotid Atherosclerotic Disease Using Dual-Targeted Microparticles of Iron Oxide

Translational Stroke Research ◽

10.1007/s12975-021-00931-3 ◽

2021 ◽

Author(s):

Joyce M. S. Chan ◽

Park Sung Jin ◽

Michael Ng ◽

Joanne Garnell ◽

Chan Wan Ying ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Iron Oxide ◽

High Risk ◽

Magnetic Resonance ◽

Carotid Artery ◽

Risk Stratification ◽

Stroke Prevention ◽

Inflammatory Activity ◽

Resonance Imaging ◽

Inflammatory Status

AbstractIdentification of patients with high-risk asymptomatic carotid plaques remains a challenging but crucial step in stroke prevention. Inflammation is the key factor that drives plaque instability. Currently, there is no imaging tool in routine clinical practice to assess the inflammatory status within atherosclerotic plaques. We have developed a molecular magnetic resonance imaging (MRI) tool to quantitatively report the inflammatory activity in atherosclerosis using dual-targeted microparticles of iron oxide (DT-MPIO) against P-selectin and VCAM-1 as a smart MRI probe. A periarterial cuff was used to generate plaques with varying degree of phenotypes, inflammation and risk levels at specific locations along the same single carotid artery in an Apolipoprotein-E-deficient mouse model. Using this platform, we demonstrated that in vivo DT-MPIO-enhanced MRI can (i) target high-risk vulnerable plaques, (ii) differentiate the heterogeneity (i.e. high vs intermediate vs low-risk plaques) within the asymptomatic plaque population and (iii) quantitatively report the inflammatory activity of local plaques in carotid artery. This novel molecular MRI tool may allow characterisation of plaque vulnerability and quantitative reporting of inflammatory status in atherosclerosis. This would permit accurate risk stratification by identifying high-risk asymptomatic individual patients for prophylactic carotid intervention, expediting early stroke prevention and paving the way for personalised management of carotid atherosclerotic disease.

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