Expansive arterial remodeling of the carotid arteries and its effect on atherosclerotic plaque composition and vulnerability: an in-vivo black-blood 3T CMR study in symptomatic stroke patients

Abstract

BackgroundBased on intravascular ultrasound of the coronary arteries expansive arterial remodeling is supposed to be a feature of the vulnerable atheroslerotic plaque. However, till now little is known regarding the clinical impact of expansive remodeling of carotid lesions. Therefore, we sought to evaluate the correlation of expansive arterial remodeling of the carotid arteries with atherosclerotic plaque composition and vulnerability using in-vivo Cardiovascular Magnetic Resonance (CMR).MethodsOne hundred eleven symptomatic patients (74 male/71.8 ± 10.3y) with acute unilateral ischemic stroke and carotid plaques of at least 2 mm thickness were included. All patients received a dedicated multi-sequence black-blood carotid CMR (3Tesla) of the proximal internal carotid arteries (ICA). Measurements of lumen, wall, outer wall, hemorrhage, calcification and necrotic core were determined. Each vessel-segment was classified according to American Heart Association (AHA) criteria for vulnerable plaque. A modified remodeling index (mRI) was established by dividing the average outer vessel area of the ICA segments by the lumen area measured on TOF images in a not affected reference segment at the distal ipsilateral ICA. Correlations of mRI and clinical symptoms as well as plaque morphology/vessel dimensions were evaluated.ResultsSeventy-eight percent (157/202) of all internal carotid arteries showed atherosclerotic disease with AHA Lesion-Type (LT) III or higher. The mRI of the ICA was significantly different in normal artery segments (AHA LT I; mRI 1.9) compared to atherosclerotic segments (AHA LT III-VII; mRI 2.5; p < 0.0001). Between AHA LT III-VII there was no significant difference of mRI. Significant correlations (p < 0.05) of the mRI with lumen-area (LA), wall-area (WA), vessel-area (VA) and wall-thickness (WT), necrotic-core area (NC), and ulcer-area were observed. With respect to clinical presentation (symptomatic/asymptomatic side) and luminal narrowing (stenotic/non-stenotic) no relevant correlations or significant differences regarding the mRI were found.ConclusionExpansive arterial remodeling exists in the ICA. However, no significant association between expansive arterial remodeling, stroke symptoms, complicated AHA VI plaque, and luminal stenosis could be established. Hence, results of our study suggest that expansive arterial remodeling is not a very practical marker for plaque vulnerability in the carotid arteries.

Severe, recurrent in-stent carotid restenosis: endovascular approach, risk factors. Results from a prospective academic registry of 2637 consecutive carotid artery stenting procedures (TARGET-CAS)

“…Severe ICA stenosis was recognized in our group of patients as a restenosis risk factor, which is consistent with observations from the study of Gaudry et al [17]. It has been found to be associated with higher plaque burden [22]. Bilateral ICA stenosis reflects considerable atherosclerosis progression and higher disease activity.…”

Evaluation of carotid plaque vulnerability in vivo: Correlation between dynamic contrast‐enhanced MRI and MRI‐modified AHA classification

“…with 10 and 4 years of experience in MRI interpretation, respectively), who were blinded to clinical information of participants. Plaques were classified according to the MRI‐modified AHA classification and subsequently labeled as MRI findings suspected to be stable (MR‐STA, including LT I–II, III, VII, and VIII) or vulnerable (MR‐VUL, including LT IV–V, and VI) …”

Review of Journal of Cardiovascular Magnetic Resonance (JCMR) 2015-2016 and transition of the JCMR office to Boston

“…Expansive remodeling is a feature of vulnerable atherosclerotic plaque. In this study by Saam and co-workers [ 170 ], 111 symptomatic patients with acute unilateral ischemic stroke and carotid plaques of at least 2 mm thickness underwent multisequence black-blood 3T CMR of the proximal internal carotid arteries. 78% of the 202 arteries examined showed evidence for atherosclerotic disease with American Heart Association (AHA) lesion type III or higher.…”