Carotid Wall Imaging with Routine Brain MRI to Facilitate Early Detection of Carotid Plaque and Intraplaque Hemorrhage

AbstractSimilar to sampling perfection with application-optimized contrast using different flip angle evolutions (SPACE), T2-weighted fast field echo (FFE) also has a black blood effect and a high imaging efficiency. The purpose of this study was to optimize 3D_T2_FFE and compare it with 3D_T2_SPACE for carotid imaging. The scanning parameter of 3D_T2_FFE was optimized for the imaging of the carotid wall. Twenty healthy volunteers and 10 patients with carotid plaque underwent cervical 3D_T2_FFE and 3D_T2_SPACE examinations. The signal-to-noise ratios of the carotid wall (SNRwall) and lumen (SNRlumen), and the contrast-to-noise ratios between the wall and lumen (CNRwall_lumen) were compared. The incidence of the residual flow signal at the carotid bifurcation and the grades of flow voids in the cerebellopontine angle region in the two sequences were also compared. The reproducibility of the two sequences was tested. No significant difference was observed between the two sequences in terms of the SNRwall of healthy individuals and patients (P = 0.132 and 0.102, respectively). The SNRlumen in the 3D_T2_FFE images was lower than that in the 3D_T2_SPACE images. No significant difference was observed between the two sequences in terms of the CNRwall-lumen. The incidence of the residual flow signal at the carotid bifurcation in 3D_T2_FFE was significantly lower than that in 3D_T2_SPACE. The grades of flow suppression in the cerebellopontine angle region in 3D_T2_SPACE was lower than that in 3D_T2_FFE. Both sequences showed excellent inter-and intra-observer reproducibility. Compared to 3D_T2_SPACE, 3D_T2_FFE showed stronger flow suppression while maintaining good imaging quality, which can be used as an alternative tool for carotid imaging.

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Abstract 3482: Increased Matrix Metalloproteinase-9 Expression is Correlated with Carotid Intraplaque hemorrhage in a Swine Model

Stroke ◽

10.1161/str.43.suppl_1.a3482 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Zhong-Song Shi ◽

Xiao-Bing Jiang ◽

Jin-Shan Wang ◽

Wei-Si Yuan ◽

Dong-Hong Liu

Keyword(s):

Carotid Artery ◽

Matrix Metalloproteinase ◽

Vulnerable Plaque ◽

Carotid Plaque ◽

Carotid Atherosclerosis ◽

Intraplaque Hemorrhage ◽

Swine Model ◽

Carotid Plaques ◽

Rete Mirabile ◽

Atherosclerotic Changes

Purpose: The limited number of large animal carotid atherosclerotic models restricts the preclinical evaluation of endovascular therapies. Carotid intraplaque hemorrhage may be associated with a higher risk of ischemic stroke in patients with carotid disease. In this study, we assess the association of the lesional expression of matrix metalloproteinase (MMP)-9 with vulnerable atherosclerotic carotid plaque and intraplaque hemorrhage in a Swine model. Materials and Methods: Carotid atherosclerosis was induced in miniswines using the combination of partial ligation and high cholesterol diet, and a minimum 70% stenosis was confirmed by Doppler ultrasonography immediately post-ligation. Carotid artery sections were obtained for histopathological examination and immunohistochemical study for MMP-9 at three months. Distal embolism was determined by the presence of atheroemboli in the ipsilateral rete mirabile. Atherosclerotic changes were classified by AHA/Stary stage (type I to VI). The association of distal embolism in the rete mirabile with vulnerable carotid plaque was analyzed. The association of MMP-9 expression in the plaque with the vulnerable plaque and intraplaque hemorrhage was further analyzed. Results: One hundred ninety-one carotid segments from ten carotid artery models were assessed. Among 139 segments with atherosclerotic changes, 102 segments had vulnerable plaque (Stary IV to VI). Vulnerable atherosclerotic plaques were found more frequently in the vessel wall proximal to the partial ligation than distal ( P <0.0001). Distal embolism was found in all 10 rete mirabilis, and deemed to be from the ipsilateral vulnerable carotid plaques. Areas positive for MMP-9 tended to be greater in the vulnerable plaque than in the stable plaque (8.69 ± 0.73% vs. 7.04 ± 0.94%, p=0.35). Areas positive for MMP-9 were significantly greater in the plaque with intraplaque hemorrhage than in the plaque without intraplaque hemorrhage (11.84 ± 1.22% vs. 6.63 ± 0.59%, p<0.001). On multivariate analysis, positive expression of MMP-9 was an independent predictor of intraplaque hemorrhage (p=0.007). Conclusion: Vulnerable carotid plaques with distal embolism were created in a Swine model of carotid atherosclerosis. Increased expression of MMP-9 may be associated with vulnerable carotid plaques, especially having the feature of intraplaque hemorrhage.

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Ultrasound Elastography: another piece in the puzzle of carotid plaque vulnerability?

Medical Ultrasonography ◽

10.11152/mu-3190 ◽

2021 ◽

Author(s):

Andjoli Davidhi ◽

Vasileios Rafailidis ◽

Evangelos Destanis ◽

Panos Prassopoulos ◽

Stefanos Foinitsis

Keyword(s):

Shear Wave ◽

Carotid Plaque ◽

Diagnostic Yield ◽

Imaging Modality ◽

Shear Wave Elastography ◽

Ultrasound Elastography ◽

Intraplaque Hemorrhage ◽

Plaque Vulnerability ◽

Carotid Plaques ◽

Increased Risk

Recent literature has shown that various carotid plaque features, other than stenosis, contribute to plaque vulnerability. Features such as surface morphology and plaque composition with distinct components (e.g. intraplaque hemorrhage, lipid core) have been associated with the increased risk of future cerebrovascular events. Ultrasonography constitutes the first line modality for the assessment of carotid disease and has traditionally been used to grade stenosis with high accuracy. Recenttechnological advances such as contrast-enhanced ultrasound and elastography increased the diagnostic yield of ultrasound in assessing the morphology of carotid plaques. The purpose of this review is to present the available literature on ultrasound elastography of the atherosclerotic carotid. Strain and shear wave elastography allow for the characterization of plaque components, thus indicating its nature and importantly, the plaque’s vulnerability. Shear wave elastography indices appear morerobust than Strain indices. Overall, elastography is a feasible method to distinguish vulnerable carotid plaques. There is, however, a need for larger and longer prospective controlled clinical studies in order to validate elastography as an imaging modality used for the detection of unstable carotid plaques.

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Gray blood magnetic resonance for carotid wall imaging and visualization of deep-seated and superficial vascular calcifications

Magnetic Resonance in Medicine ◽

10.1002/mrm.24445 ◽

2012 ◽

Vol 70 (1) ◽

pp. 75-85 ◽

Cited By ~ 9

Author(s):

Ioannis Koktzoglou

Keyword(s):

Magnetic Resonance ◽

Vascular Calcifications ◽

Carotid Wall ◽

Wall Imaging

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Reclassification of Ischemic Stroke Etiological Subtypes on the Basis of High-Risk Nonstenosing Carotid Plaque

Stroke ◽

10.1161/strokeaha.119.027970 ◽

2020 ◽

Vol 51 (2) ◽

pp. 504-510 ◽

Cited By ~ 11

Author(s):

Hooman Kamel ◽

Babak B. Navi ◽

Alexander E. Merkler ◽

Hediyeh Baradaran ◽

Iván Díaz ◽

...

Keyword(s):

Ischemic Stroke ◽

High Risk ◽

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Acute Stroke ◽

Carotid Plaque ◽

Brain Infarction ◽

Intraplaque Hemorrhage ◽

Large Artery ◽

Stroke Subtypes

Background and Purpose— Carotid artery plaque with <50% luminal stenosis may be an underappreciated stroke mechanism. We assessed how many stroke causes might be reclassified after accounting for nonstenosing plaques with high-risk features. Methods— We included patients enrolled in the Cornell Acute Stroke Academic Registry from 2011 to 2015 who had anterior circulation infarction, magnetic resonance imaging of the brain, and magnetic resonance angiography of the neck. High-risk plaque was identified by intraplaque hemorrhage ascertained from routine neck magnetic resonance angiography studies using validated methods. Infarct location was determined from diffusion-weighted imaging. Intraplaque hemorrhage and infarct location were assessed separately in a blinded fashion by a neuroradiologist. We used the McNemar test for matched data to compare the prevalence of intraplaque hemorrhage ipsilateral versus contralateral to brain infarction. We reclassified stroke subtypes by including large-artery atherosclerosis as a cause if there was intraplaque hemorrhage ipsilateral to brain infarction, regardless of the degree of stenosis. Results— Among the 1721 acute ischemic stroke patients registered in the Cornell Acute Stroke Academic Registry from 2011 to 2015, 579 were eligible for this analysis. High-risk plaque was more common ipsilateral versus contralateral to brain infarction in large-artery atherosclerotic (risk ratio [RR], 3.7 [95% CI, 2.2–6.1]), cryptogenic (RR, 2.1 [95% CI, 1.4–3.1]), and cardioembolic strokes (RR, 1.7 [95% CI, 1.1–2.4]). There were nonsignificant ipsilateral-contralateral differences in high-risk plaque among lacunar strokes (RR, 1.2 [95% CI, 0.4–3.5]) and strokes of other determined cause (RR, 1.5 [95% CI, 0.7–3.3]). After accounting for ipsilateral high-risk plaque, 88 (15.2%) patients were reclassified: 38 (22.6%) cardioembolic to multiple potential etiologies, 6 (8.5%) lacunar to multiple, 3 (15.8%) other determined cause to multiple, and 41 (20.8%) cryptogenic to large-artery atherosclerosis. Conclusions— High-risk carotid plaque was more prevalent ipsilateral to brain infarction across several ischemic stroke subtypes. Accounting for such plaques may reclassify the etiologies of up to 15% of cases in our sample.

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Carotid Plaque Morphology is Similar in Patients with Reduced and Normal Renal Function

Clinical Medicine Insights Cardiology ◽

10.1177/1179546820951793 ◽

2020 ◽

Vol 14 ◽

pp. 117954682095179

Author(s):

Caroline Heijl ◽

Fredrik Kahn ◽

Andreas Edsfeldt ◽

Christoffer Tengryd ◽

Jan Nilsson ◽

...

Keyword(s):

Renal Function ◽

Carotid Plaque ◽

Continuous Variable ◽

Intraplaque Hemorrhage ◽

Plaque Morphology ◽

Plaque Vulnerability ◽

Vulnerable Atherosclerotic Plaque ◽

Increased Risk ◽

Plaque Phenotype ◽

Tissue Calcium

Background: Chronic Kidney Disease (CKD) is associated with an increased risk for cardiovascular events such as stroke. However, it is still unclear if decreased kidney function is associated with a vulnerable atherosclerotic plaque phenotype. To explore if renal function was associated with carotid plaque vulnerability we analyzed carotid plaques obtained at surgery from the Carotid Plaque Imaging Project (CPIP). Methods: Patients were enrolled through the CPIP cohort. The indication for surgery was plaques with stenosis >70%, associated with ipsilateral symptoms or plaques with stenosis >80% not associated with symptoms. Transversal sections from the most stenotic plaque region were analyzed for connective tissue, calcium, lipids, macrophages, intraplaque hemorrhage, and smooth muscle cells. Homogenates were analyzed for collagen and elastin. Results: Carotid endarterectomy specimens from 379 patients were obtained. The median GFR was 73 ml/min/1.73 m2. Plaque characteristics showed no significant association with eGFR, neither when eGFR was divided in CKD groups nor when eGFR was handled as a continuous variable and adjusting for other known risk factors (ie, age, diabetes, hypertension, and smoking). Conclusions: The higher risk of cardiovascular disease such as stroke in CKD is not associated with increased plaque vulnerability and other factors have to be sought.

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Dilated microvessel with endothelial cell proliferation involves intraplaque hemorrhage in unstable carotid plaque

Acta Neurochirurgica ◽

10.1007/s00701-020-04595-0 ◽

2020 ◽

Author(s):

Daina Kashiwazaki ◽

Shusuke Yamamoto ◽

Naoki Akioka ◽

Emiko Hori ◽

Takashi Shibata ◽

...

Keyword(s):

Cell Proliferation ◽

Endothelial Cell ◽

Carotid Plaque ◽

Intraplaque Hemorrhage ◽

Endothelial Cell Proliferation

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Hemoglobin A1c as A Potential Indicator for Intraplaque Hemorrhage of Carotid Artery Atherosclerosis in Asymptomatic Adults

10.21203/rs.3.rs-370709/v1 ◽

2021 ◽

Author(s):

Yu Wang ◽

Runhua Zhang ◽

Yong Jiang ◽

Miaoxin Yu ◽

Huiyu Qiao ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Plaque ◽

Hemoglobin A1c ◽

Univariate Analysis ◽

Intraplaque Hemorrhage ◽

Stepwise Logistic Regression ◽

Community Based ◽

Stepwise Logistic Regression Analysis ◽

Cross Sectional ◽

High Hba1c

Abstract BackgroundTo investigate the association between hemoglobin A1c (HbA1c) and intraplaque hemorrhage (IPH) in carotid atherosclerotic plaque detected by high-resolution magnetic resonance imaging (HR-MRI) in a community-based population. MethodsIn this cross-sectional, community-based study, a total of 598 participants were recruited from May 2015 to September 2019. All participants underwent carotid artery HR-MRI. Data on demographics, medical history, and physical examinations were obtained through face-to-face interview, and fasting blood sample were collected. HbA1c was determined using high-performance liquid chromatographic analysis. Presence or absence of carotid plaque IPH was determined by HR-MRI. Multiple stepwise logistic regression analysis was performed to investigate the association between HbA1c levels and carotid plaque IPH. ResultsOf the 598 participants, 317 (53.0%) had atherosclerotic plaques, and 25 (4.2%) had IPH in carotid arteries. HbA1c was associated with the presence of IPH (OR, 1.94; 95% CI, 1.38-2.73) in the univariate analysis, and the association remained significant after adjustment for age, sex, traditional vascular factors, high-sensitivity C-reactive protein, and other potential confounders (OR, 1.70; 95% CI, 1.14-2.52).ConclusionsThis study showed that high HbA1c was associated with carotid plaque IPH detected by HR-MRI, which suggests that individuals with high HbA1c may have a higher risk of developing vulnerable carotid plaques.

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