Association Between Carotid Plaque Characteristics and Subsequent Ischemic Cerebrovascular Events

Abstract

Background and Purpose-MRI is able to quantify carotid plaque size and composition with good accuracy and reproducibility and provides an opportunity to prospectively examine the relationship between plaque features and subsequent cerebrovascular events. We tested the hypothesis that the characteristics of carotid plaque, as assessed by MRI, are possible predictors of future ipsilateral cerebrovascular events. Methods-A total of 154 consecutive subjects who initially had an asymptomatic 50% to 79% carotid stenosis by ultrasound with Ն12 months of follow-up were included in this study. Multicontrast-weighted carotid MRIs were performed at baseline, and participants were followed clinically every 3 months to identify symptoms of cerebrovascular events. Results-Over a mean follow-up period of 38.2 months, 12 carotid cerebrovascular events occurred ipsilateral to the index carotid artery. Cox regression analysis demonstrated a significant association between baseline MRI identification of the following plaque characteristics and subsequent symptoms during follow-up: presence of a thin or ruptured fibrous cap (hazard ratio, 17.0; PՅ0.001), intraplaque hemorrhage (hazard ratio, 5.2; Pϭ0.005), larger mean intraplaque hemorrhage area (hazard ratio for 10 mm 2 increase, 2.6; Pϭ0.006), larger maximum %lipid-rich/necrotic core (hazard ratio for 10% increase, 1.6; Pϭ0.004), and larger maximum wall thickness (hazard ratio for a 1-mm increase, 1.6; Pϭ0.008). Conclusions-Among patients who initially had an asymptomatic 50% to 79% carotid stenosis, arteries with thinned or ruptured fibrous caps, intraplaque hemorrhage, larger maximum %lipid-rich/necrotic cores, and larger maximum wall thickness by MRI were associated with the occurrence of subsequent cerebrovascular events. Findings from this prospective study provide a basis for larger multicenter studies to assess the risk of plaque features for subsequent ischemic events. (Stroke. 2006;37:818-823.)

Association of Intraplaque Hemorrhage and Acute Infarction in Patients With Basilar Artery Plaque

“…[4][5][6][7] Xu et al 12 reported that the occurrence rate of high-intensity signal was significantly different between symptomatic and asymptomatic MCAs. In our study, MR-positive IPHs within BA plaques were found in 30 patients (42.3%).…”

“…Among the T1-weighted MR sequences, black-blood T1-weighted fast spin-echo and 3D TOF angiography are currently used for clinical examination. 1,4,6,10 In the present study, we used MPRAGE because recent research has shown that this sequence has higher sensitivity and specificity in detecting hemorrhage compared with blackblood T1-weighted fast spin-echo and TOF angiography. 6 The MPRAGE sequence combined with contrast-enhanced T1-weighted and TOF angiography is more practical for the evaluation of carotid plaque components, including IPH.…”

“…3 IPH in carotid atherosclerotic plaques is significantly associated with more rapid progression of plaque size, the presence of a lipid-rich necrotic core, and the progression of luminal stenosis. 1,4,5 High-resolution magnetic resonance imaging (HRMRI) is ideal for serial examinations of diseased arterial walls because it is noninvasive and has superior capability of discriminating tissue characteristics when compared with other imaging modalities.…”

Obesity Is Associated With Progression of Atherosclerosis During Statin Treatment

“…Table 3 provides an overview of prior studies 15, 29, 30. Many factors influence the overall changes in atherosclerosis including study population, prior statin therapy, and intensity of statin therapy.…”

“…Prior IVUS and MRI studies of the response to statin therapy have focused primarily on high‐risk patients with cardiovascular events or high degrees of plaque 15, 16. Prior studies have not assessed change of atherosclerosis in lower risk patients receiving statin therapy; small sample sizes have prevented assessment of factors that modify atheroma response to statins.…”