Carotid Intraplaque Hemorrhage Is Associated with Cardiovascular Risk Factors

Abstract

Introduction: Intraplaque hemorrhage (IPH) is a known predictor of symptomatic cervical carotid artery disease. However, the association between IPH and modifiable cardiovascular risk factors, patient demographics, and pertinent laboratory values has not been extensively studied. Methods: A retrospective review was performed of consecutive patients who have undergone dedicated carotid plaque imaging over a 3-year period. Patients were excluded if the MR examination did not include high-resolution carotid plaque imaging. Intraplaque hyperintense signal on carotid plaque images was presumed to represent IPH. The presence or absence of IPH was compared to various demographic and clinical variables. Multivariable regression analysis was performed in order to determine an independent association between variables and IPH. Results: Of 643 included patients, 114 patients (17.7%) had IPH in one or both carotids, 529 patients (82.3%) did not; 39.5% of patients with IPH had coronary artery disease compared to 23.1% of patients without (p = 0.0003). Patients with IPH also had higher proportions of hypertension (77.2 vs. 60.7%, p = 0.009), hyperlipid-emia (HLD; 89.5 vs. 62.4%, p < 0.0001), diabetes mellitus (29.0 vs. 18.7%, p = 0.01), and a history of tobacco smoking (63.2 vs. 52.6%, p = 0.003). Patients without IPH had, on average, higher high-density lipoprotein levels (46.1 vs. 56.7%, p = 0.003). Factors independently associated with IPH were advanced age (odds ratio [OR]: 1.1, 95% CI: [1.0-1.05], p < 0.0001), male sex (OR: 2.5, 95% CI: [1.4-4.4], p = 0.0001), presence of carotid stenosis (OR: 8.4, 95% CI: [4.6-15.3], p < 0.0001), and HLD (OR: 2.6, 95% CI: [1.3-5.2], p = 0.009). Conclusions: IPH is associated with multiple cardiovascular risk factors, in particular advanced age, male sex, presence of carotid stenosis, and HLD. Such risk factors likely play a role in the development of IPH and may provide insight into the pathophysiology of unstable carotid plaques.

Integrated head and neck imaging of symptomatic patients with stroke using simultaneous non-contrast cardiovascular magnetic resonance angiography and intraplaque hemorrhage imaging as compared with digital subtraction angiography

“…A previous study found that IPH in carotid plaques using MPRAGE imaging was associated with age, sex, degree of stenosis, and hyperlipidemia [ 35 ], which was, not observed in our study. This may be related to the cohort characteristics where patients with primarily moderate to severe arterial stenosis were included; some also had partial occlusions.…”

Radiomics assessment of carotid intraplaque hemorrhage: detecting the vulnerable patients

“…If the IPH occurs, the treatment approach of the patient is significantly altered [ 16 , 17 ]. Previous studies have tried to differentiate carotid plaques with IPH and those without IPH by using stenosis [ 18 ]. Several studies found that plaques with IPH in the carotid artery showed greater stenosis than those without IPH [ 15 , 18 ], which are consistent with our studies.…”

“…Previous studies have tried to differentiate carotid plaques with IPH and those without IPH by using stenosis [ 18 ]. Several studies found that plaques with IPH in the carotid artery showed greater stenosis than those without IPH [ 15 , 18 ], which are consistent with our studies. The reason may be that the stenosis of the lumen affected hemodynamic parameters, which in turn affected the status of intraplaque neovascularization.…”

Predictors of Progression in Intraplaque Hemorrhage Volume in Patients With Carotid Atherosclerosis: A Serial Magnetic Resonance Imaging Study

“…Previous studies investigated the risk factors for the presence of IPH and found that that increasing patient's age, male sex, taking an antiplatelet agent, increase in degree of stenosis, or elevated lipids were the risk factors (10,19,23,24). Of these risk factors, in this study, taking an antiplatelet agent and larger baseline carotid plaque-containing vessel wall volume (a related parameter to increasing degree of stenosis) were also found to be associated with plaques in the progressed IPH group.…”