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

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

The Neuroradiology Journal ◽

10.1177/1971400920970920 ◽

2020 ◽

Vol 33 (6) ◽

pp. 494-500

Author(s):

Anthony S Larson ◽

Waleed Brinjikji ◽

Luis Savastano ◽

Eugene Scharf ◽

John Huston ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Arteries ◽

Carotid Artery Disease ◽

Underlying Mechanism ◽

Intraplaque Hemorrhage ◽

Asymmetric Distribution ◽

Anterior Circulation ◽

Asymptomatic Patients ◽

Left And Right ◽

Artery Disease

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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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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Cerebral dysautoregulation and the risk of ischemic events in occlusive carotid artery disease

Journal of Neurology ◽

10.1007/s00415-008-0865-z ◽

2008 ◽

Vol 255 (8) ◽

pp. 1182-1189 ◽

Cited By ~ 41

Author(s):

M. Reinhard ◽

T. A. Gerds ◽

D. Grabiak ◽

P. R. Zimmermann ◽

M. Roth ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Disease ◽

Artery Disease ◽

Ischemic Events

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Three-Dimensional Geometry of the Human Carotid Artery

Journal of Biomechanical Engineering ◽

10.1115/1.4006810 ◽

2012 ◽

Vol 134 (6) ◽

Cited By ~ 17

Author(s):

Alexey V. Kamenskiy ◽

Jason N. MacTaggart ◽

Iraklis I. Pipinos ◽

Jai Bikhchandani ◽

Yuris A. Dzenis

Keyword(s):

Carotid Artery ◽

Carotid Artery Disease ◽

Three Dimensional ◽

External Carotid ◽

Cross Sectional ◽

Geometrical Features ◽

The Mean ◽

The Cross ◽

Artery Disease ◽

Artery Geometry

Accurate characterization of carotid artery geometry is vital to our understanding of the pathogenesis of atherosclerosis. Three-dimensional computer reconstructions based on medical imaging are now ubiquitous; however, mean carotid artery geometry has not yet been comprehensively characterized. The goal of this work was to build and study such geometry based on data from 16 male patients with severe carotid artery disease. Results of computerized tomography angiography were used to analyze the cross-sectional images implementing a semiautomated segmentation algorithm. Extracted data were used to reconstruct the mean three-dimensional geometry and to determine average values and variability of bifurcation and planarity angles, diameters and cross-sectional areas. Contrary to simplified carotid geometry typically depicted and used, our mean artery was tortuous exhibiting nonplanarity and complex curvature and torsion variations. The bifurcation angle was 36 deg ± 11 deg if measured using arterial centerlines and 15 deg ± 14 deg if measured between the walls of the carotid bifurcation branches. The average planarity angle was 11 deg ± 10 deg. Both bifurcation and planarity angles were substantially smaller than values reported in most studies. Cross sections were elliptical, with an average ratio of semimajor to semiminor axes of 1.2. The cross-sectional area increased twofold in the bulb compared to the proximal common, but then decreased 1.5-fold for the combined area of distal internal and external carotid artery. Inter-patient variability was substantial, especially in the bulb region; however, some common geometrical features were observed in most patients. Obtained quantitative data on the mean carotid artery geometry and its variability among patients with severe carotid artery disease can be used by biomedical engineers and biomechanics vascular modelers in their studies of carotid pathophysiology, and by endovascular device and materials manufacturers interested in the mean geometrical features of the artery to target the broad patient population.

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