scholarly journals Correlation of Carotid Intraplaque Hemorrhage and Stroke Using 1.5 T and 3 T Mri

2015 ◽  
Vol 8s1 ◽  
pp. MRI.S23560 ◽  
Author(s):  
Gerald S. Treiman ◽  
J. Scott McNally ◽  
Seong-Eun Kim ◽  
Dennis L. Parker
Keyword(s):  
Risk Stratification ◽  
Carotid Plaque ◽  
The United States ◽  
Intraplaque Hemorrhage ◽  
Specific Information ◽  
Plaque Instability ◽  
Asymptomatic Patients ◽  
Cerebral Ischemic ◽  
Ischemic Events ◽  
Current Risk

Carotid therosclerotic disease causes approximately 25% of the nearly 690,000 ischemic strokes each year in the United States. Current risk stratification based on percent stenosis does not provide specific information on the actual risk of stroke for most individuals. Prospective randomized studies have found only 10 to 12% of asymptomatic patients will have a symptomatic stroke within 5 years. Measurements of percent stenosis do not determine plaque stability or composition. Reports have concluded that cerebral ischemic events associated with carotid plaque are intimately associated with plaque instability. Analysis of retrospective studies has found that plaque composition is important in risk stratification. Only MRI has the ability to identify and measure the detailed components and morphology of carotid plaque and provides more detailed information than other currently available techniques. MRI can accurately detect carotid hemorrhage, and MRI identified carotid hemorrhage correlates with acute stroke.

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

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.

Impact of sex and age on carotid plaque instability in asymptomatic patients-results from the Munich Vascular Biobank

VASA ◽  
2016 ◽  
Vol 45 (5) ◽  
pp. 411-416 ◽  
Author(s):  
Carina Wendorff ◽  
Heiko Wendorff ◽  
Andreas Kuehnl ◽  
Pavlos Tsantilas ◽  
Michael Kallmayer ◽  
...  
Keyword(s):  
Carotid Plaque ◽  
Statistical Significance ◽  
Old Patients ◽  
Continuous Increase ◽  
Plaque Instability ◽  
Female Sex ◽  
Asymptomatic Patients ◽  
Unstable Plaques ◽  
The Impact ◽  
Asymptomatic Men

Abstract. Background: It is still a controversial issue whether carotid endarterectomy (CEA) for asymptomatic carotid stenosis is superior to best medical treatment. The aim of this study was therefore to analyze the impact of sex and age on carotid plaque instability in asymptomatic patients undergoing CEA. Patients and methods: Atherosclerotic plaques from 465 asymptomatic patients with high-grade carotid artery stenosis (2004 - 2013) at the Munich Vascular Biobank were analyzed. Ascertainment of lesion stability/instability was performed on formalin-fixed paraffin-embedded tissue samples using hematoxylin-eosin and elastic van Gieson staining. Unstable plaques were considered lesions with a fibrous cap < 200 µm overlaying lipid-rich atheroma. Results: The average age of the patients was 69.3 ± 8.2 years. Independent of age, asymptomatic men had in total more frequently unstable plaques in contrast to women (41 % versus 52%, p = 0.042). No differences were found in plaque instability between age-related quartiles (< 65, 65- 69, 70 - 74, > 74 years) for female sex (p = 0.422). In men, a continuous increase in plaque instability with age was observed, without achieving statistical significance (p = 0.125). The greatest differences between male and female sex were found in the last quartile (> 74 years), without achieving statistical significance (p = 0.053). The chance of unstable carotid plaques in men was significantly higher than in women (OR = 1.562, p = 0.040). The probability of age-associated quartiles related to the first quartile demonstrated significant increase in plaque instability in the group of 65- to 69-year-old patients (OR 1.867, p = 0.024) and for patients older than 74 years (OR 1.740, p = 0.040). Conclusions: Asymptomatic men had in total more frequently unstable plaques in contrast to women. Thus, male sex seems to be an additional risk factor for ischemic stroke.

Abstract TMP119: Early Cerebral Ischemic Events in Symptomatic Carotid Stenosis are Related to Plaque Inflammation

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Prakash R Paliwal ◽  
Arvind K Sinha ◽  
Hock L Teoh ◽  
James Hallinan ◽  
Zhengdao Du ◽  
...  
Keyword(s):  
Cerebral Ischemia ◽  
Carotid Stenosis ◽  
Fdg Pet ◽  
Carotid Plaque ◽  
Stroke Recurrence ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Plaque Inflammation ◽  
Cerebral Ischemic ◽  
Ischemic Events

Background and aims: Symptomatic carotid stenosis is associated with an increased risk of early stroke recurrence. Severity of the stenosis, current basis of revascularization, explains only the cerebral ischemic mechanism of regional hypoperfusion. Plaque inflammation, the initiating event for plaque rupture and thromboembolism (artery-to-artery embolism), is not evaluated routinely. Using 18F-fluorodeoxyglucose positron-emission tomography (FDG-PET)/computed tomography (CT) and high resolution magnetic resonance imaging (HR-MRI), we investigated the role of plaque imaging and stroke recurrence in our cohort of stroke patients with recently symptomatic carotid stenosis. Methods: This ongoing prospective study included consecutive patients within 30-days of recent stroke and ipsilateral carotid stenosis (≥50%). FDG uptake was quantified as mean standardized uptake values (SUV, g/ml). The ratio of T1 hyperintensity of carotid plaque to the ipsilateral sternocleidomastoid muscle (SCM) was recorded on T1-weighted fat suppressed images. Patients were followed prospectively for stroke recurrence within 90-days. Embolic potential of carotid plaque is estimated by presence of spontaneous microembolic signals (MES) on extended transcranial Doppler monitoring of ipsilateral middle cerebral artery. Results: Of the 33 patients included in the study, 6 (18%) suffered from recurrent cerebral ischemic event in the same vascular territory within 90-days. Compared to patients without subsequent cerebral ischemic events, patients with recurrent cerebral ischemia showed higher mean T1 carotid-SCM ratio (2.49 versus 1.53; p<0.0001) and higher mean SUV value in the carotid plaque (3.52g/ml versus 1.51g/ml; p<0.0001). Higher T1 carotid-SCM ratio on HR-MRI (OR 4.249, 95%CI 1.818-5.18; p<0.0001), higher mean SUV on FDG-PET (OR 3.050, 95%CI 5.586-28.571; p=0.005) and MES on TCD (OR 2.186, 95%CI 1.652-47.619;p=0.037) were independent predictors of recurrent cerebral ischemia. Conclusions: FDG-PET/CT and HR-MRI imaging of carotid stenosis helps in identification of patients at higher risk of subsequent cerebral ischemic events and may aid in better therapeutic decision-making.

Abstract WP218: Assessment of Carotid Plaque Vulnerability Using Quantitative Expansive Remodeling Evaluation and MRI Plaque Signal Intensity

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Yoshitaka Kurosaki ◽  
Kazumichi Yoshida ◽  
Ryu Fukumitsu ◽  
Masaomi Koyanagi ◽  
Nobutake Sadamasa ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Signal Intensity ◽  
Carotid Plaque ◽  
Plaque Vulnerability ◽  
Plaque Volume ◽  
Carotid Mri ◽  
Group A ◽  
Group B ◽  
Group D ◽  
Ischemic Events

Background: Assessment of plaque vulnerability is important in evaluating the future risk of stroke. Plaque characteristics and plaque volume are important components of plaque vulnerability. Expansive remodeling (ER) is one of the criteria for vulnerable plaque in the coronary arteries, and influences the plaque volume. The aim of this study is risk stratification of carotid plaque through the evaluation of quantitative ER and MRI plaque signal intensity. Methods: We studied and obtained both pre-operation carotid MRI T1-weighted axial and long axis images of 72 patients who underwent carotid endarterectomy or carotid aretery stenting. ER ratio (ERR) was calculated from the ratio of the linear diameter of the artery at the thickest segment of the plaque to the diameter of the artery beyond any poststenotic dilatation on the long axis image on carotid MRI. We also calculated relative plaque signal intensity (rSI) from the axial image and grouped the patients as follows: Group A, rSI≥1.4 and ERR≥1.8; Group B, rSI<1.4 and ERR≥1.8; Group C, rSI≥1.4 and ERR<1.8; Group D, rSI<1.4 and ERR<1.8. Ischemic events within 6 months were retrospectively evaluated in each group. Results: Of the 72 patientis, the number of patients in each group was as follows: Group A, 20 patients; B, 12 patients; C, 19 patients; D, 21 patients. Fifteen patients (75%) in Group A, 6 patients (50%) in Group B, 8 patients (42%) in Group C and 7 patients (33%) in Group D had ischemic events within 6 months. Ischemic events in Group A was significantly higher than in Group C and D (p<0.05, p<0.001). Conclusion: The combined assessment of plaque characterization with MRI and morphological evaluation using ERR are useful in risk stratification for carotid lesions.

scholarly journals Carotid artery plaque assessment using quantitative expansive remodeling evaluation and MRI plaque signal intensity

2016 ◽  
Vol 124 (3) ◽  
pp. 736-742 ◽  
Author(s):  
Yoshitaka Kurosaki ◽  
Kazumichi Yoshida ◽  
Ryu Fukumitsu ◽  
Nobutake Sadamasa ◽  
Akira Handa ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Risk Stratification ◽  
Signal Intensity ◽  
Plaque Vulnerability ◽  
Carotid Artery Plaque ◽  
Asymptomatic Patients ◽  
Group A ◽  
Group B ◽  
Group D ◽  
Ischemic Events

OBJECT Plaque characteristics and morphology are important indicators of plaque vulnerability. MRI-detected intraplaque hemorrhage has a great effect on plaque vulnerability. Expansive remodeling, which has been considered compensatory enlargement of the arterial wall in the progression of atherosclerosis, is one of the criteria of vulnerable plaque in the coronary circulation. The purpose of this study was risk stratification of carotid artery plaque through the evaluation of quantitative expansive remodeling and MRI plaque signal intensity. METHODS Both preoperative carotid artery T1-weighted axial and long-axis MR images of 70 patients who underwent carotid endarterectomy (CEA) or carotid artery stenting (CAS) were studied. The expansive remodeling ratio (ERR) was calculated from the ratio of the linear diameter of the artery at the thickest segment of the plaque to the diameter of the artery on the long-axis image. Relative plaque signal intensity (rSI) was also calculated from the axial image, and the patients were grouped as follows: Group A = rSI ≥ 1.40 and ERR ≥ 1.66; Group B = rSI< 1.40 and ERR ≥ 1.66; Group C = rSI ≥ 1.40 and ERR < 1.66; and Group D = rSI < 1.40 and ERR < 1.66. Ischemic events within 6 months were retrospectively evaluated in each group. RESULTS Of the 70 patients, 17 (74%) in Group A, 6 (43%) in Group B, 7 (44%) in Group C, and 6 (35%) in Group D had ischemic events. Ischemic events were significantly more common in Group A than in Group D (p = 0.01). CONCLUSIONS In the present series of patients with carotid artery stenosis scheduled for CEA or CAS, patients with plaque with a high degree of expansion of the vessel and T1 high signal intensity were at higher risk of ischemic events. The combined assessment of plaque characterization with MRI and morphological evaluation using ERR might be useful in risk stratification for carotid lesions, which should be validated by a prospective, randomized study of asymptomatic patients.

Abstract WP125: Comparison Of Carotid Intraplaque Hemorrhage With Other Markers Of Plaque Vulnerability.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Joseph S McNally ◽  
Seong-Eun Kim ◽  
Hyo-Chun Yoon ◽  
John Roberts ◽  
Krishna Narra ◽  
...  
Keyword(s):  
Relative Risk ◽  
Acute Stroke ◽  
Carotid Plaque ◽  
Systemic Disease ◽  
The Body ◽  
Intraplaque Hemorrhage ◽  
Plaque Vulnerability ◽  
Intraluminal Thrombus ◽  
Brain Images ◽  
Ischemic Events

Background: MR detected carotid intraplaque hemorrhage (IPH) has been associated with acute ischemic events. Other markers of plaque vulnerability can also be imaged by MRI/MRA and include >70% carotid stenosis, plaque ulceration, and intraluminal thrombus. Atherosclerosis is a systemic disease, and many of these markers are found bilaterally in patients. Objective: To determine the relative risk acute ischemic events with carotid IPH compared to other markers of plaque vulnerability, and to determine whether IPH is associated with these markers and contralateral IPH. Methods: Over 2 years, 159 patients with suspected acute stroke were evaluated with brain DTI and MRA neck workup. Carotid MRA included lumen evaluation as well as carotid plaque imaging with the MPRAGE sequence. This provided 318 carotid artery and ipsilateral brain images for analysis. 48 arteries were excluded due to extracarotid sources of brain ischemia and 4 were excluded due to carotid occlusion. 266 arteries were eligible for data analysis. Results: Acute territorial ischemic events were associated with carotid IPH, >70% stenosis, ulceration and intraluminal thrombus (relative risk=6.4 (4.3-8.7), 4.4 (2.8-5.9), 3.8 (2.4-5.6), and 5.7 (3.6-5.7) respectively, p<0.001). Within the same carotid plaque, IPH was associated with ulceration and >70% stenosis (relative risk=7.8 (4.4-13.1) and 6.0 (2.6-13.8) respectively, p<0.001). There was a trend toward association with intraluminal thrombus, but this did not reach significance (relative risk=3.4 (0.9-12.4), p=0.056). Carotid IPH also increased the relative risk of contralateral carotid IPH (relative risk=6.3, (3.4-10.9), p<0.001). Conclusions: Carotid IPH is associated with acute stroke, with a relative risk on par with other markers of plaque vulnerability. Carotid IPH is highly associated with ulceration or >70% stenosis. Carotid IPH is also associated with contralateral IPH, suggesting that systemic factors result in plaque hemorrhage elsewhere in the body.

scholarly journals The Risk of Carotid Plaque Instability in Patients with Metabolic Syndrome: It is Higher in Women with Hypertriglyceridemia

2021 ◽  
Author(s):  
Francesca Servadei ◽  
Lucia Anemona ◽  
Marina Cardellini ◽  
Manuel Scimeca ◽  
Manuela Montanaro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Carotid Plaque ◽  
Cerebrovascular Diseases ◽  
Plaque Instability ◽  
Female Patients ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Unstable Plaques ◽  
Plaque Destabilization

Abstract Background: Metabolic syndrome certainly favors growth of carotid plaque; however, it is uncertain if it determines plaque destabilization. Furthermore, it is likely that only some components of metabolic syndrome are associated with increased risk of plaque destabilization. Therefore, we evaluated the effect of different elements of metabolic syndrome, individually and in association, on carotid plaques destabilization. Methods: A total of 186 carotid endarterectomies from symptomatic and asymptomatic patients were histologically analysed and correlated with major cardiovascular risk factors. Results: Metabolic syndrome, regardless of the cluster of its components, is not associated with a significant increase in risk of plaque destabilization, rather with the presence of stable plaques. The incidence of unstable plaques in patients with metabolic syndrome is quite low (43.9%), when compared with that seen in the presence of some risk factors, but significantly increases in the subgroup of female patients with hypertriglyceridemia, showing an odds ratio of 3.01 (CI 95% 0.25 - 36.30). Conclusions: Our data may help to identify patients with real increased risk of acute cerebrovascular diseases and may support the hypothesis that the control of hypertriglyceridemia should be a key point on prevention of carotid atherosclerotic plaque destabilization, especially in post-menopausal female patients. Keywords: Metabolic syndrome, carotid, histology, hypertriglyceridemia , post-menopause.

Multimodal ultrasound parameters aided carotid plaque risk stratification in patients with asymptomatic carotid stenosis

2021 ◽  
pp. 028418512198918
Author(s):  
Yi Li ◽  
Shuai Zheng ◽  
Jinghan Zhang ◽  
Fumin Wang ◽  
Wen He
Keyword(s):  
Risk Stratification ◽  
Carotid Stenosis ◽  
Carotid Plaque ◽  
Regression Analyses ◽  
Asymptomatic Carotid Stenosis ◽  
Vascular Events ◽  
Asymptomatic Carotid ◽  
Asymptomatic Patients ◽  
Proximal Internal Carotid Artery ◽  
Multivariable Regression

Background Risk stratification of asymptomatic carotid plaque remains an issue in stroke prevention in clinical practice. Purpose To investigate whether a multimodal ultrasound (MMU) model would help plaque risk stratification in patients with asymptomatic carotid stenosis. Material and Methods A prospective study was conducted of symptomatic and asymptomatic patients with > 50% proximal internal carotid artery (ICA) stenosis. All patients underwent MMU examination. Multivariable regression analyses were performed to identify parameters associated with ischemic vascular events (IVE). These parameters were used to develop a scoring nomogram to assess the probability of IVE. We elaborated the diagnostic performance of the MMU nomogram using receiver operating characteristic (ROC) curves. Results From December 2018 to December 2019, 98 patients (75 men, mean age 67 ± 8 years) were included; 50 were symptomatic and 48 were asymptomatic. Multivariable regression analyses revealed that plaque surface morphology (PSM) (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.26–7.12, P = 0.013), intraplaque neovascularization (IPN) grades (OR 3.23, 95% CI 1.77–5.89, P<0.001), and carotid stenosis degree (CSD) (OR 4.12, 95% CI 1.47–11.55, P = 0.007) were independently associated with IVE. For the nomogram, the area under the ROC curve was 0.85 (95% CI 0.77–0.92) and the Hosmer-Lemeshow test P value was 0.822. Conclusions In patients with proximal ICA > 50%, PSM, IPN grades, and CSD were independent variables associated with IVE. The MMU nomogram provided favorable value to risk stratification of IVE. Future large-scale studies with long-term follow-up are needed to validate these findings.

scholarly journals High Sensitivity C-Reactive Protein Increases the Risk of Carotid Plaque Instability in Male Dyslipidemic Patients

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2117
Author(s):  
Manuel Scimeca ◽  
Manuela Montanaro ◽  
Marina Cardellini ◽  
Rita Bonfiglio ◽  
Lucia Anemona ◽  
...  
Keyword(s):  
Carotid Plaque ◽  
Smoking Habit ◽  
Density Lipoprotein ◽  
Heart Association ◽  
High Sensitivity ◽  
C Reactive Protein ◽  
Plaque Instability ◽  
Reactive Protein ◽  
Asymptomatic Patients ◽  
Hs Crp

Background: The aim of this study was to evaluate how the high sensitivity C-reactive protein (hs-CRP) values influence the risk of carotid plaque instability in association with other cardiovascular risk factors. Methods: One hundred and fifty-six carotid plaques from both symptomatic and asymptomatic patients requiring surgical carotid endarterectomy were retrospectively collected. According to the modified American Heart Association, atherosclerosis plaques have been histologically distinguished into unstable and stable. The following anamnestic and hematochemical data were also considered: age, gender, hypertension, diabetes mellitus, smoking habit, therapy, low-density lipoprotein (LDL)-C, kidney failure and hs-CRP. Results: The results of our study clearly show that high levels of hs-CRP significantly increase the carotid plaque instability in dyslipidemic patients. Specifically, a 67% increase of the risk of carotid plaque instability was observed in patients with high LDL-C. Therefore, the highest risk was observed in male dyslipidemic patients 2333 (95% CI 0.73–7.48) and in aged female patients 2713 (95% CI 0.14–53.27). Discussion: These data strongly suggest a biological relationship between the hs-CRP values and the alteration of lipidic metabolism mostly in male patients affected by carotid atherosclerosis. The measurement of hs-CRP might be useful as a potential screening tool in the prevention of atheroscletotic disease.

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