Intraplaque high-intensity signal on time-of-flight magnetic resonance angiography and restenosis after carotid artery stenting

2021 ◽  
pp. 1-6
Author(s):  
Keisuke Tokunaga ◽  
So Tokunaga ◽  
Kenta Hara ◽  
Masahiro Yasaka ◽  
Yasushi Okada ◽  
...  
Keyword(s):  
Carotid Artery ◽  
High Intensity ◽  
Carotid Artery Stenting ◽  
Time Of Flight ◽  
Peak Systolic Velocity ◽  
Intraplaque Hemorrhage ◽  
Tof Mra ◽  
Increased Risk ◽  
High Intensity Signal

OBJECTIVE To test the hypothesis that intraplaque hemorrhage is a predictor of restenosis after carotid artery stenting (CAS), the association between intraplaque high-intensity signal (HIS) on time-of-flight MR angiography (TOF-MRA), as a marker of intraplaque hemorrhage, and restenosis after CAS was assessed in the present observational study. METHODS Consecutive patients who underwent initial CAS for atherosclerotic stenosis in the cervical internal carotid artery in the authors’ department were enrolled. Of these, patients without preprocedural cervical TOF-MRA were excluded. Outcome measures were ≥ 50% restenosis, defined as a peak systolic velocity of > 1.3 m/sec; or occlusion and ≥ 70% restenosis, defined as a peak systolic velocity of > 2.1 m/sec; or occlusion on carotid duplex ultrasound. RESULTS Of 230 consecutive patients who underwent initial CAS, 22 without preprocedural cervical TOF-MRA were excluded. Of the remaining 208 patients (mean age 73 years; 33 women), 46 had intraplaque HIS. Ultrasound follow-up was not performed in 4 patients. The median follow-up duration was 3.2 years (interquartile range 1.7–5.1 years). During the follow-up period, 102 patients had ≥ 50% restenosis and 36 had ≥ 70% restenosis. Intraplaque HIS was significantly associated with increased risk of ≥ 50% restenosis (adjusted hazard ratio 2.18; 95% CI 1.28–3.68) and ≥ 70% restenosis (adjusted hazard ratio 3.12; 95% CI 1.32–7.52). CONCLUSIONS Intraplaque HIS on TOF-MRA was associated with increased risk of restenosis after CAS. The present results indicate that intraplaque hemorrhage is a predictor of restenosis after CAS.

Carotid artery stenosis with a high-intensity signal plaque on time-of-flight magnetic resonance angiography and association with evidence of intraplaque hypoxia

2016 ◽  
Vol 126 (6) ◽  
pp. 1873-1878 ◽  
Author(s):  
Atsushi Ogata ◽  
Masatou Kawashima ◽  
Tomihiro Wakamiya ◽  
Masashi Nishihara ◽  
Jun Masuoka ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Carotid Artery ◽  
High Intensity ◽  
Time Of Flight ◽  
University Hospital ◽  
Intraplaque Hemorrhage ◽  
Carotid Plaques ◽  
Tof Mra ◽  
The Relationship

OBJECTIVEHypoxia induces angiogenesis and plays a major role in the progression of carotid plaques. During carotid intervention, plaques with high-intensity signals on time-of-flight (TOF) magnetic resonance angiography (MRA) often cause ischemic stroke and embolic complications. However, the role of intraplaque hypoxia before carotid endarterectomy (CEA) and carotid artery stenting is not presently understood. In this study the authors aimed to investigate the relationship between intraplaque hypoxia and MRA findings.METHODSNineteen consecutive patients with 20 carotid artery stenoses who underwent CEA at Saga University Hospital between August 2008 and December 2014 were enrolled in the study. The expressions of hypoxia-inducible transcription factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) were analyzed by immunohistochemical analysis. In addition, the relationship between the findings on TOF MRA and pathology for the carotid plaques was analyzed.RESULTSHigh-intensity plaques on TOF MRA showed higher expression levels of HIF-1α (p = 0.015) and VEGF (p = 0.007) compared with isointensity plaques. The rate of intraplaque hemorrhage (IPH) on TOF MRA was also significantly higher in the high-intensity plaques than in the isointensity plaques (p = 0.024). Finally, the mean number of neovessels was significantly higher in those without plaque hemorrhage than in those with plaque hemorrhage (p = 0.010).CONCLUSIONSPlaques with high-intensity signals on TOF MRA were associated with IPH and evidence of intraplaque hypoxia. This fact may represent an opportunity to establish novel therapeutic agents targeting intraplaque hypoxia.

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 Diabetes mellitus and carotid artery plaques exhibiting high-intensity signals on MR angiography are related to increased platelet reactivity after carotid artery stenting

2016 ◽  
Vol 9 (1) ◽  
pp. 106-110 ◽  
Author(s):  
Masanori Tsujimoto ◽  
Yukiko Enomoto ◽  
Jouji Kokuzawa ◽  
Toru Iwama
Keyword(s):  
Diabetes Mellitus ◽  
Multivariate Analysis ◽  
Carotid Artery ◽  
High Intensity ◽  
Carotid Artery Stenting ◽  
Mr Angiography ◽  
Clinical Characteristics ◽  
Platelet Reactivity ◽  
Thromboembolic Complications ◽  
Tof Mra

BackgroundIncreased platelet reactivity after carotid artery stenting (CAS) may cause thromboembolic complications.ObjectiveThis study aimed to investigate the incidence of increased platelet reactivity after CAS and to determine the factors related to it.MethodsPatients who underwent CAS were recruited prospectively. They received pre-procedural antiplatelet therapy comprising some combination of aspirin (100 mg/day), clopidogrel (75 mg/day), and/or cilostazol (200 mg/day) for a minimum of 7 days. ADP- and collagen-induced platelet aggregation were measured before and 4 days after CAS. Changes in platelet reactivity were reported as changes in the categorized platelet reactivity grade based on the effective dose 50%. Clinical characteristics of patients with and without increased platelet reactivity were compared.ResultsAmong 38 consecutive patients who underwent CAS, 18 (47%) exhibited increased platelet reactivity. Diabetes mellitus (OR 15.0; 95% CI 2.1 to 106.5; p=0.007) and carotid artery plaques exhibiting high-intensity signals (HIS) on time-of-flight MR angiography (TOF-MRA) (OR 25.2; 95% CI 2.0 to 316.2; p=0.013) were independently associated with increased platelet reactivity in a multivariate analysis.ConclusionsIncreased platelet reactivity occurred in nearly half of the studied patients subjected to CAS and was independently associated with diabetes mellitus and carotid artery plaques exhibiting HIS on TOF-MRA.

Abstract 3: Restenosis following Carotid Artery Stenting and Endarterectomy in the Carotid Revascularization Endarterectomy versus Stenting Trial

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Brajesh K Lal ◽  
Kirk W Beach ◽  
Gary S Roubin ◽  
Helmi L Lutsep ◽  
Wesley S Moore ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Proportional Hazards ◽  
Peak Systolic Velocity ◽  
Composite Endpoint ◽  
Carotid Revascularization ◽  
Repeat Revascularization ◽  
Kaplan Meier ◽  
Additional Procedure

Objectives The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) showed no difference in the composite endpoint of stroke, myocardial infarction, or death between carotid artery stenting (CAS) and carotid endarterectomy (CEA) in patients with symptomatic or asymptomatic carotid stenosis (CS). We compared restenosis or occlusion, and repeat revascularization, between CAS and CEA over 2 years of follow-up. Methods Restenosis, occlusion, and repeat revascularization were assessed at 1, 6, 12 and 24 months post-randomization. Hemodynamically significant restenosis (≥70% diameter reduction) was defined by a peak systolic velocity (PSV) ≥300 cm/second on standardized duplex ultrasonography (DUS), occlusion by an absence of flow within the target artery on DUS, and repeat revascularization by any additional procedure (CEA, angioplasty or CAS) performed on the index artery. Studies were performed in CREST-certified laboratories and interpreted in the CREST Ultrasound Core Lab. Patients included in this report were those who received their assigned treatment within 30 days of randomization and had an ultrasound reviewed at the Core Lab (n=2191). Treatment differences were assessed using proportional hazards models adjusting for age, sex, and symptomatic status. Results In the analytic cohort, 1086 patients received CAS and 1105 received CEA. Over 2 years 113 patients developed restenosis, 56 (rate 5.8%) in the CAS group and 57 (rate 5.8%) in the CEA group; and 8 developed an occlusion, 3 (rate 0.3 %) in the CAS group and 5 (rate 0.5%) in the CEA group. The combined restenosis-occlusion rate was 6.0% (n=58) for CAS and 6.3% (n=62) for CEA (HR=0.90, 95% CI=0.63-1.29, p=0.58). Forty-three patients of the 2191 underwent repeat revascularization (20 CAS, 23 CEA, p=0.69) of which 28 had restenosis by our criteria and so were included ( Figure ). Stroke occurred in 13 (4 CAS; 9 CEA) of the 120 patients with restenosis or occlusion; 1 of the 4 CAS strokes occurred after restenosis was detected, and 5 of 9 CEA strokes occurred after restenosis was detected. Conclusions This analysis of carotid restenosis is the largest reported to date from any randomized clinical trial. Restenosis and occlusion were infrequent and similar up to 2 years following CAS or CEA among 2191 patients. The rates of revascularization likewise did not differ between CAS and CEA. Follow-up out to 10 years is ongoing. Figure. Kaplan-Meier curves of restenosis and occlusion over 2 years.

scholarly journals Association between Pericytes in Intraplaque Neovessels and Magnetic Resonance Angiography Findings

2020 ◽  
Vol 21 (6) ◽  
pp. 1980 ◽  
Author(s):  
Atsushi Ogata ◽  
Tomihiro Wakamiya ◽  
Masashi Nishihara ◽  
Tatsuya Tanaka ◽  
Taichiro Mizokami ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
High Intensity ◽  
Carotid Plaque ◽  
Intraplaque Hemorrhage ◽  
Carotid Plaques ◽  
Tof Mra ◽  
Group 4 ◽  
High Intensity Signal ◽  
Cluster Of Differentiation

(1) Background: Pericytes are involved in intraplaque neovascularization of advanced and complicated atherosclerotic lesions. However, the role of pericytes in human carotid plaques is unclear. An unstable carotid plaque that shows high-intensity signals on time-of-flight (TOF) magnetic resonance angiography (MRA) is often a cause of ischemic stroke. The aim of the present study is to examine the relationship between the pericytes in intraplaque neovessels and MRA findings. (2) Methods: A total of 46 patients with 49 carotid artery stenoses who underwent carotid endarterectomy at our hospitals were enrolled. The patients with carotid plaques that were histopathologically evaluated were retrospectively analyzed. Intraplaque hemorrhage was evaluated using glycophorin A staining, and intraplaque neovessels were evaluated using CD34 (Cluster of differentiation) stain as an endothelial cell marker or NG2 (Neuron-glial antigen 2) and CD146 stains as pericyte markers. Additionally, the relationships between the TOF-MRA findings and the carotid plaque pathologies were evaluated. (3) Results: Of the 49 stenoses, 28 had high-intensity signals (TOF-HIS group) and 21 had iso-intensity signals (TOF-IIS group) on TOF-MRA. The density of the CD34-positive neovessels was equivalent in both groups. However, the NG2- and CD146-positive neovessels had significantly higher densities in the TOF-HIS group than in the TOF-IIS group. (4) Conclusion: The presence of a high-intensity signal on TOF-MRA in carotid plaques was associated with intraplaque hemorrhage and few pericytes in intraplaque neovessels. These findings may contribute to the development of new therapeutic strategies focusing on pericytes.

Increased Rates of Hemorrhages after Endovascular Stroke Treatment with Emergency Carotid Artery Stenting and Dual Antiplatelet Therapy

2021 ◽  
pp. 1-9
Author(s):  
Felix Hadler ◽  
Raveena Singh ◽  
Martin Wiesmann ◽  
Arno Reich ◽  
Omid Nikoubashman
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Antiplatelet Therapy ◽  
Carotid Artery Stenting ◽  
Dual Antiplatelet Therapy ◽  
Stroke Treatment ◽  
Systemic Thrombolysis ◽  
Stroke Registry ◽  
Increased Risk ◽  
Arterial Thrombolysis

<b><i>Background:</i></b> While endovascular stroke treatment (EST) of large vessel occlusions in acute ischemic stroke (AIS) is proven to be safe and effective, there are subgroups of patients with increased rates of hemorrhages. Our goal was to identify risk factors for intracerebral hemorrhage and to assess whether acute carotid artery stenting (CAS) was associated with increased bleeding rates. <b><i>Methods:</i></b> We performed a retrospective analysis of our monocentric prospective stroke registry in the period from May 2010 to May 2018 and compared AIS patients receiving EST with (<i>n</i> = 73) versus without acute CAS (<i>n</i> = 548). Patients with intracranial stents, intra-arterial thrombolysis, or dissection of the carotid artery were excluded. <b><i>Results:</i></b> Parenchymal hemorrhage rates (PH2 according to the ECASS classification) and symptomatic hemorrhage (sICH) rates were increased in EST patients receiving CAS with odds being 6.3 (PH2) and 6.5 (sICH) times higher (PH2 17.8 vs. 3.3%, <i>p</i> &#x3c; 0.001 and sICH: 16.4 vs. 2.9%, <i>p</i> &#x3c; 0.001). Additional systemic thrombolysis with rtPA (IVRTPA) was no risk factor for cerebral hemorrhage (<i>p</i> = 0.213). <b><i>Conclusion:</i></b> AIS patients receiving EST with acute CAS and consecutive tirofiban or dual antiplatelet therapy suffered from an increased risk of relevant secondary intracranial bleeding. After adjusting for confounders, tirofiban and dual antiplatelet therapy were associated with higher bleeding rates.

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