Carotid plaque magnetic resonance imaging and recurrent stroke risk

Abstract

Background & Aims: Carotid atherosclerotic plaque is an important cause of carotid artery stenosis. The features of carotid atherosclerotic plaque detected by relevant magnetic resonance imaging (MRI), such as lipid core, plaque hemorrhage, and fibrous cap rupture, have been confirmed to be associated with the occurrence of the first cerebral ischemic event. Meanwhile, the features of carotid atherosclerotic plaque can be used as biomarkers to predict the occurrence of cerebral ischemic event. However, the mechanism of recurrent stroke is still unclear. A systematic review and meta-analysis will be performed to summarize the association between features of carotid artery plaque detected by MRI and recurrent stroke, so as to find biomarkers that can predict recurrent stroke. Methods: Electronic search will be performed in PUBMED, EMBASE, Cochrane Controlled Register of Trials (CENTRAL) from inception to October 30, 2018. We will include cohort studies with an average follow-up time of >1 month in which lipid-rich/necrotic cores (LRNC), intraplaque hemorrhage (IPH), and thinned or ruptured fibrous caps (TRFC) are associated with recurrent ipsilateral stroke or ischemic events. We will perform heterogeneity assessment before carrying out meta-analysis. According to the heterogeneity, we select random effect model or fixed effect model for meta-analysis of the included cohort studies. Results: Review Manager 5.3 software will be used to calculate the combined hazard ratio value and 95% confidence interval (CI). This meta-analysis will provide high-quality data analysis of LRNC, IPH, and TRFC and ipsilateral recurrent stroke or ischemic events, including biomarkers as major predictors. Conclusion: The systematic review will provide evidence to assess the association between features of carotid plaque and ipsilateral recurrent stroke or ischemic events. PROSPERO registration number: PROSPERO CRD42019124043.

3D-Arterial analysis software and CEUS in the assessment of severity and vulnerability of carotid atherosclerotic plaque: a comparison with CTA and histopathology

“…Over the last few years, the vulnerability features of atherosclerotic plaque have been extensively studied for the estimation of CVA risk especially in asymptomatic individuals that are eligible for medical treatment or revascularization. In fact, the ipsilateral ischemic cerebrovascular events are more common in patients with high-risk plaques (4.3 events per 100 person-years) than in those without high-risk plaques (1.2 events per 100 person-years), with an odds ratio of 3.0 [32,33].…”

Black‐Blood Contrast in Cardiovascular MRI

“…A recent technique permits 3D acquisition and simultaneous depiction of the vessel wall and the vascular lumen using a combined bright‐ and black‐blood imaging sequence 91 . Modern black‐blood MRI techniques of the carotid bifurcation are highly accurate for identifying carotid atherosclerosis, including intraplaque hemorrhage 92,93 and patients at increased risk for stroke 94–96 …”

“…91 Modern black-blood MRI techniques of the carotid bifurcation are highly accurate for identifying carotid atherosclerosis, including intraplaque hemorrhage 92,93 and patients at increased risk for stroke. [94][95][96] Although imaging the vessel wall of medium-sized arteries is possible at a field strength of 1.5T, 97-99 use of higher field strengths such as 3.0T and 7.0T allow 3D isotropic submillimeter spatial resolution acquisitions while maintaining sufficient SNR and has been shown to significantly improve coronary artery vessel wall image quality, 100,101 depiction of atherosclerosis in small intracranial arteries, 102,103 (Fig. 9) and even plaque rupture in patients with acute myocardial infarction.…”

“… 91 Modern black‐blood MRI techniques of the carotid bifurcation are highly accurate for identifying carotid atherosclerosis, including intraplaque hemorrhage 92 , 93 and patients at increased risk for stroke. 94 , 95 , 96 …”

Cardiovascular risk factors and cervical carotid plaque features on CT angiography

“…The majority of such studies have focused on the use of magnetic resonance imaging (MRI), while computed tomography angiography (CTA) has remained mainly relegated to assessing the degree of arterial stenosis. 1,2 Nevertheless, CTA is a well-established tool for the assessing carotid atherosclerosis. 3 Like MRI, CTA can be used to characterize multiple plaque features.…”