Left-sided carotid arteries have a higher prevalence of intraplaque hemorrhage than right-sided: An asymmetric conundrum

Purpose To assess whether an asymmetry exists in the prevalence of carotid artery intraplaque hemorrhage (IPH) between right- and left-sided arteries. Materials and methods The records of all patients with atherosclerotic carotid artery disease that underwent neck magnetic resonance angiography imaging with high-resolution plaque sequences between 2017 and 2020 at our institution were retrospectively reviewed. The prevalence of stenosis and IPH was determined for all patients and compared between the left and right carotid arteries of those with unilateral anterior circulation ischemic strokes. Multiple regression analysis was performed to determine potential independent associations of IPH laterality with ischemic strokes. Results A total of 368 patients were included overall and 241 were male (65.4%). There were a total of 125 asymptomatic patients and 211 patients with unilateral anterior circulation ischemic strokes. Of patients with ischemic strokes, 55.5% had left-sided strokes compared with 44.5% who had right-sided strokes ( p = 0.03). Patients with left-sided strokes had a higher prevalence of ipsilateral IPH than those with right-sided strokes (64.1% versus 36.2%, p < 0.0001), despite similar degrees of stenosis. Both age (odds ratio (OR): 1.0; 95% confidence interval (CI): 1.0–1.1; p = 0.007) and the presence of left-sided IPH (OR: 3.2; 95% CI: 1.5–6.8; p = 0.003) were independently associated with unilateral ischemic strokes. Conclusions Left-sided plaques more frequently have IPH and may be more likely to result in ipsilateral ischemic strokes compared with right-sided plaques. The underlying mechanism of asymmetric distribution of IPH between right and left carotids remains unclear.

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Variations in the Presence of Carotid Intraplaque Hemorrhage Across Age Categories: What Age Groups Are Most Likely to Benefit From Plaque Imaging?

Frontiers in Neurology ◽

10.3389/fneur.2020.603055 ◽

2020 ◽

Vol 11 ◽

Author(s):

Anthony S. Larson ◽

John C. Benson ◽

Waleed Brinjikji ◽

Luis Savastano ◽

Giuseppe Lanzino ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Disease ◽

Age Groups ◽

Intraplaque Hemorrhage ◽

Plaque Imaging ◽

Anterior Circulation ◽

The Mean ◽

Artery Disease ◽

Cerebral Ischemic ◽

Ischemic Events

Although carotid artery intraplaque hemorrhage (IPH) is a known risk-factor for cerebral ischemic events in patients of advanced age, its prevalence in younger cohorts is less certain. The purpose of this study was to assess the prevalence of carotid artery IPH across the age spectrum. A retrospective review was completed of all adult patients from our institution who underwent neck MRA with high-resolution carotid plaque imaging between 2017 and 2020. The mean ages of patients with and without IPH were calculated. The prevalence of IPH was compared between patients that were categorized into age groups. Patients with and without a cerebral ischemic event (e.g., stroke, retinal ischemia) were included. Unilateral anterior circulation ischemic events in patients without atrial fibrillation were presumed to be likely related to ipsilateral carotid artery disease. Multiple regression analysis was performed to determine independent associations with IPH. 634 patients were included (1,268 carotid arteries). Increasing age (OR: 1.04; 95% CI: 1.02–1.06; P = 0.001) was independently associated with IPH. 211 patients had unilateral anterior circulation ischemic events. The mean age of patients with carotid IPH was 71.4 years (SD = 9.9), compared to 62.8 years (SD = 15.8) of those without (P ≤ 0.0001). The prevalence of IPH increased with age in all patients (P = 0.0002). Among patients with ipsilateral anterior circulation ischemic events, each age category above 50 years had a significantly higher prevalence of IPH when compared to patients 18–50 years (P ≤ 0.05 for all comparisons). The prevalence of carotid IPH increases with age and is rare in patients under 50 years. The approximate threshold age for IPH development is likely around 50 years.

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Contrast Enhanced Ultrasound: Visualization of Far Field and Classification of Plaque in the Extracranial Carotid Arteries

Journal for Vascular Ultrasound ◽

10.1177/1544316718783739 ◽

2018 ◽

Vol 42 (3) ◽

pp. 109-115 ◽

Cited By ~ 1

Author(s):

Paige L. Rowland ◽

Michelle Colpitts ◽

Angela Malone ◽

Munis Raza ◽

Lenora L. Eberhart ◽

...

Keyword(s):

Image Quality ◽

Carotid Artery ◽

Carotid Arteries ◽

Carotid Artery Disease ◽

Plaque Morphology ◽

Far Field ◽

Contrast Enhanced Ultrasound ◽

Contrast Imaging ◽

Contrast Enhanced ◽

Artery Disease

Ultrasound stratification for the degree of carotid artery disease based solely on lumen reduction has poorly predicted patient outcomes. This pilot study focused on patients with moderate carotid artery stenosis. Our purpose was to use contrast imaging with ultrasound to improve carotid field. A total of 10 patients diagnosed with moderate carotid artery stenosis were rescanned with an administration of a contrast imaging agent. Two-dimensional (2D) imaging, color, and Doppler were utilized to scan the patients. The 20 carotid arteries were blindly read by 2 experienced physicians. Visualization of far field, quality of Doppler envelope, plaque morphology, and overall image quality were semi-quantifiably assessed. With the use of a contrast imaging agent, there was a reduction in interphysician interpretation variability. The Kappa coefficient yielded an increase in agreement for postcontrast imaging in the majority of variables. The Doppler envelope showed improvement from precontrast (0.06) to postcontrast (0.63). The visualization of the far fields demonstrated a significant increase in agreement (0.77, 0.71, and 0.67) postcontrast. Plaque morphology demonstrated enhancement in characterization with contrast (–0.09 to 0.66). In this study, contrast-enhanced ultrasound (CEUS) was found to increase overall image quality. Improved interpretation can enhance risk stratification and with further exploration could be used to guide treatment plans for patients with asymptomatic moderate carotid artery disease.

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Clinical Significance of Intraplaque Hemorrhage in Carotid Artery Disease

Journal of Neuroimaging ◽

10.1111/jon19988115 ◽

1998 ◽

Vol 8 (1) ◽

pp. 15-19 ◽

Cited By ~ 15

Author(s):

Henrik Sillesen ◽

Tina Nielsen

Keyword(s):

Carotid Artery ◽

Clinical Significance ◽

Carotid Artery Disease ◽

Intraplaque Hemorrhage ◽

Artery Disease

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Coronary Artery Disease and Carotid Artery Disease Progress Despite Normal Lipid Levels by Standard Statin Therapy in Asymptomatic Patients without Known Coronary Artery Disease: Implications for Statin Therapy

Enliven Clinical Cardiology and Research ◽

10.18650/2375-7310.12003 ◽

2014 ◽

Vol 01 (02) ◽

Author(s):

Iwasaki Kohichiro ◽

Matsumoto Takeshi

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Carotid Artery ◽

Statin Therapy ◽

Carotid Artery Disease ◽

Lipid Levels ◽

Disease Progress ◽

Asymptomatic Patients ◽

Artery Disease

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SHA 20. Carotid artery disease in asymptomatic patients. What to do?

Journal of the Saudi Heart Association ◽

10.1016/j.jsha.2010.02.293 ◽

2010 ◽

Vol 22 (2) ◽

pp. 90

Author(s):

Mohamed Abd Alwahab

Keyword(s):

Carotid Artery ◽

Carotid Artery Disease ◽

Asymptomatic Patients ◽

Artery Disease

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Carotid Artery Disease

The Diabetes Educator ◽

10.1177/014572178501100107 ◽

1985 ◽

Vol 11 (1) ◽

pp. 37-39 ◽

Cited By ~ 1

Author(s):

David R. Campbell

Keyword(s):

Carotid Artery ◽

Carotid Arteries ◽

Carotid Artery Disease ◽

Definitive Diagnosis ◽

Noninvasive Techniques ◽

Artery Disease

Because macroangiopathy is a ma jor complication of diabetes, evalua tion of the carotid arteries for possible obstruction is of primary importance. Patients with transient ischemic at tacks, a precursor of strokes, are liable to have either a mechanical reduction of flow secondary to stenosis or a re lease of emboli from extracranial plaques. After a definitive diagnosis by angiogram, dissection of a tight lesion is indicated. Asymptomatic bruits should be evaluated by noninvasive techniques for possible prophylactic endarterectomy.

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C-reactive Protein is Elevated in Symptomatic Compared with Asymptomatic Patients with Carotid Artery Disease

European Journal of Vascular and Endovascular Surgery ◽

10.1053/ejvs.2002.1632 ◽

2002 ◽

Vol 23 (6) ◽

pp. 505-509 ◽

Cited By ~ 16

Author(s):

K. Rerkasem ◽

C.P. Shearman ◽

J.A. Williams ◽

G.E. Morris ◽

M.J. Phillips ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Disease ◽

C Reactive Protein ◽

Reactive Protein ◽

Asymptomatic Patients ◽

Artery Disease

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Abstract WP233: Validation of Multi-parametric Ultrasonography Criteria With Catheter Angiography in Internal Carotid Artery Disease: a Multicenter Study

Stroke ◽

10.1161/str.47.suppl_1.wp233 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Kristian Barlinn ◽

Henning Rickmann ◽

Ali Rabahi ◽

Hagen H Kitzler ◽

Andrij Abramyuk ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Carotid Arteries ◽

Internal Carotid ◽

Carotid Artery Disease ◽

False Negative ◽

Catheter Angiography ◽

True Negative ◽

Artery Disease ◽

Extracranial Ica

Introduction: Novel multi-parametric criteria for duplex ultrasonography (DUS) grading of extracranial internal carotid artery (ICA) steno-occlusive disease have been recently introduced by the German ultrasound expert panel (DEGUM). We sought to determine diagnostic accuracy of the DEGUM criteria against the gold standard catheter angiography. Methods: We prospectively enrolled consecutive patients who routinely underwent diagnostic or therapeutic catheter angiography of the extracranial carotid arteries in four German study sites. Internal carotid artery disease was graded according to the DEGUM multi-parametric criteria for DUS. On angiography, extracranial ICA disease was graded using the NASCET approach. Ultrasonography and endovascular raters were blinded to clinical data and any other imaging modalities. To correspond to clinically relevant NASCET groups, all stenosis measurements were stratified into ranges: normal, mild (1-49%), moderate (50-69%), severe (70-99%) and occlusion. Results: We studied 130 patients who underwent both DUS and catheter angiography for assessment of carotid arteries (mean age, 64±11 years; 67% men; median time between DUS and angiography, 1 day [interquartile range, 2.5]). To date, fifty-two carotid artery pairs were independently rated and available for comparative analysis. Compared with catheter angiography, DUS had the following positive (PPV) and negative predictive values (NPV): PPV 50% and NPV 72% (3 true positive, 3 false positive, 33 true negative, 13 false negative) for detection of moderate, and PPV 57% and NPV 77% (20 true positive, 15 false positive, 13 true negative, 4 false negative) for detection of severe stenosis. Conclusions: Our preliminary data indicate that the novel DEGUM multi-parametric ultrasonography criteria do not eliminate the need for a confirmatory test for identification of clinically relevant grades of extracranial ICA disease.

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Selection of Treatment for Patients with Carotid Artery Disease: Medication, Carotid Endarterectomy, or Carotid Artery Stenting

Vascular ◽

10.1258/rsmvasc.13.2.92 ◽

2005 ◽

Vol 13 (2) ◽

pp. 92-97 ◽

Cited By ~ 3

Author(s):

Marc Bosiers ◽

Patrick Peeters ◽

Koen Deloose ◽

Jürgen Verbist ◽

L. Richard Sprouse

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Medical Therapy ◽

Carotid Artery Stenting ◽

Carotid Artery Disease ◽

Limiting Factors ◽

Treatment Modalities ◽

Asymptomatic Patients ◽

Artery Disease ◽

Selection Of

Patients presenting with atherosclerosis of the extracranial carotid arteries may be offered carotid endarterectomy (CEA), carotid artery stenting (CAS), or medical therapy to reduce their risk of stroke. In many cases, the choice between treatment modalities remains controversial. An algorithm based on patients' neurologic symptoms, comorbidities, limiting factors for CAS and CEA, and personal preferences was developed to determine the optimal treatment in each case. This algorithm was then employed to determine therapy in 308 consecutive patients presenting to a single institution during one calendar year. Ninety-five (30.8%) patients presented with an asymptomatic carotid stenosis of more than 80% and 213 (69.2%) with a symptomatic stenosis of more than 50%. According to our algorithm, 59 (62.1%) of the 95 asymptomatic patients received CAS, 20 (21.1%) received CEA, and 16 (16.8%) received medical therapy. All symptomatic patients underwent intervention; 153 (71.8%) were treated with CAS and 60 (28.2%) with CEA. Combined 30-day stroke and death rates after CAS were 1.7% in asymptomatic patients and 2.6% in symptomatic patients. After CEA, these rates were 0% and 3.3%, respectively. Careful selection of treatment modality according to predetermined criteria can result in improved outcomes.

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