The annual progression of carotid wall volume is independently associated with recurrent ischemic cerebrovascular events, and this measurement has added value for intraplaque hemorrhage and fibrous cap rupture in predicting future events.

Aim: The present study aimed to investigate the association between shape and location of atherosclerotic plaques and intraplaque hemorrhage (IPH) in carotid arteries using magnetic resonance (MR) imaging. Methods: Overall, 114 symptomatic patients (mean age: 64.9±10.9 years; 81 males) who underwent MR imaging and had advanced carotid plaques were included in analysis. IPH presence and carotid plaque shape and location (below and above bifurcation) were evaluated. The plaque shape was defined as follows: type-I: the arc-length of plaque is greater in the upstream; type-II: the arc-length of plaque in downstream and upstream is equal; and type-III: the arc-length of plaque is greater in downstream. The plaque shape and location were compared between plaques with and without IPH and their associations with IPH were determined. Results: Of 181detectedplaques, 57 (31.5%) had IPH. Compared with plaques without IPH, those with IPH had higher incidence of the plaque shape of type-I (66.7% vs. 32.2%, P <0.001), lower incidence of plaque shape of type-III (24.6% vs. 50.0%, P =0.001), and were more likely located above carotid bifurcation (71.9% vs. 48.4%, P =0.003). The plaque shape of type-I (OR, 4.01; 95%CI, 1.36–11.83; P =0.012) and location above bifurcation (OR, 3.21; 95%CI, 1.07–9.61; P =0.037) of carotid plaques were significantly associated with IPH after adjusting for confounder factors. Conclusions: Carotid plaque shape and location are significantly associated with the occurrence of IPH. Our findings could provide new insights for the pathogenesis of IPH and vulnerably plaques.

Aim: To investigate the association between the volumes of different aging intraplaque hemorrhage (IPH) and minor fibrous cap disruption (MFCD) in carotid arteries.Methods: Patients with cerebrovascular symptoms and carotid atherosclerotic plaques determined by ultrasound were recruited and underwent multi-contrast magnetic resonance (MR) vessel wall imaging for carotid arteries. Carotid plaques with IPH on MR imaging were included in the analysis. The age (fresh or recent) and the volume of IPH for each plaque were evaluated.Results: In total, 41 carotid plaques in 37 patients (mean age 70.2 ± 11.0 years old; 32 males) were eligible for statistical analysis. The absolute volume of fresh IPH in plaques with MFCD was significantly larger than that in plaques without MFCD (109.83 ± 75.49 mm3 vs. 30.54 ± 20.62 mm3, P = 0.002). Logistic regression showed that the absolute volume of fresh IPH was significantly associated with MFCD before (odds ratio [OR], 1.735; 95% confidence interval [CI], 1.127–2.670; P = 0.012) and after adjusting for confounding factors (OR, 1.823; 95% CI, 1.076–3.090; P = 0.026). There was no significant association between recent IPH volume and MFCD (P > 0.05).Conclusion: The volume of fresh IPH is independently associated with MFCD in carotid plaques, suggesting that integrity of fibrous cap may change with different age and size of IPH.

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ObjectivesWe aimed to compare the long-term outcomes and surgical benefits between moyamoya disease (MMD) and atherosclerosis-associated moyamoya vasculopathy (AS-MMV) using high-resolution MRI (HRMRI).MethodsMMV patients were retrospectively included and divided into the MMD and AS-MMV groups according to vessel wall features on HRMRI. Kaplan-Meier survival and Cox regression were performed to compare the incidence of cerebrovascular events and prognosis of encephaloduroarteriosynangiosis (EDAS) treatment between MMD and AS-MMV.ResultsOf the 1173 patients (mean age: 42.4±11.0 years; male: 51.0%) included in the study, 881 were classified into the MMD group and 292 into the AS-MMV group. During the average follow-up of 46.0±24.7 months, the incidence of cerebrovascular events in the MMD group was higher compared with that in the AS-MMV group before (13.7% vs 7.2%; HR 1.86; 95% CI 1.17 to 2.96; p=0.008) and after propensity score matching (6.1% vs 7.3%; HR 2.24; 95% CI 1.34 to 3.76; p=0.002). Additionally, patients treated with EDAS had a lower incidence of events than those not treated with EDAS, regardless of whether they were in the MMD (HR 0.65; 95% CI 0.42 to 0.97; p=0.043) or AS-MMV group (HR 0.49; 95% CI 0.51 to 0.98; p=0.048).ConclusionsPatients with MMD had a higher risk of ischaemic stroke than those with AS-MMV, and patients with both MMD and AS-MMV could benefit from EDAS. Our findings suggest that HRMRI could be used to identify those who are at a higher risk of future cerebrovascular events.

Background: Carotid vulnerable plaque is a major cause of stroke and differs between men and women. Few studies have investigated the differences in carotid plaque features between sexes in a Chinese population. Purpose: To compare carotid atherosclerotic plaque features between men and women in a Chinese population using magnetic resonance imaging. Study type: Cross-sectional. Subjects: A total of 567 patients (mean age: 61.5 AE 10.1 years; 404 men) who had recent stroke or transient ischemia attack and atherosclerotic plaque in at least one carotid artery. Field strength: A 3.0 T. Sequence: T1-and T2-weighted turbo spin echo, three-dimensional time-of-flight (TOF) fast field echo and magnetizationprepared rapid acquisition gradient echo sequences. Assessment: Plaque characteristics including lumen area (LA), wall area (WA), total vessel area (TVA), mean wall thickness (MWT), and mean normalized wall index (NWI); presence of calcification, lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and fibrous cap rupture (FCR); and percent composition area (%area) were evaluated and compared between men and women. Statistical tests: Independent-sample t test, Mann-Whitney U test, chi-square test, and multiple linear and logistic regressions. Results: In symptomatic arteries, men had significantly greater LA (46.2 AE 15.6 mm 2 vs. 40.7 AE 12.9 mm 2 , P < 0.05), WA (33.9 AE 11.5 mm 2 vs. 26.3 AE 7.5 mm 2 , P < 0.05), and TVA (80.1 AE 20.4 mm 2 vs. 67.0 AE 18.0 mm 2 , P < 0.05); higher MWT (1.2 AE 0.4 mm vs. 1.0 AE 0.2 mm, P < 0.05); and higher prevalence of LRNC (72.3% vs. 46.0%, P < 0.05) and IPH (18.6% vs. 4.9%, P < 0.05) compared with women. In asymptomatic arteries, men had significantly greater LA (48.3 AE 16.9 mm 2 vs. 42.1 AE 12.6 mm 2 , P < 0.05), WA (32.9 AE 11.0 mm 2 vs. 25.8 AE 6.1 mm 2 , P < 0.05), and TVA (81.2 AE 22.1 mm 2 vs. 67.9 AE 16.5 mm 2 , P < 0.05); higher MWT (1.2 AE 0.3 mm vs. 1.0 AE 0.2 mm, P < 0.05); higher prevalence of LRNC (67.8% vs. 42.9%, P < 0.05), IPH (14.9% vs. 1.2%, P < 0.05), and FCR (6.4% vs. 1.2%, P < 0.05); and higher %LRNC area (24.8 AE 17.2% vs. 17.8 AE 14.1%, P < 0.05) compared with women. Data conclusion: Men have similar plaque burden but more vulnerable atherosclerotic plaques compared with women in both symptomatic and asymptomatic carotid arteries in a Chinese population. Evidence Level: 4 Technical Efficacy: Stage 3

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