Eccentric Stenosis of the Carotid Artery Associated with Ipsilateral Cerebrovascular Events

Ohara, Tomoyuki; Toyoda, Kazunori; Otsubo, Ryoichi; Nagatsuka, K; Kubota, Yasuhiko; Yasaka, Masahiro; Naritomi, Hiroaki; Minematsu, Kazuo

doi:10.3174/ajnr.a0997

Cited by 57 publications

(29 citation statements)

References 35 publications

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“…8 As for clinical relevance of plaque eccentricity, a clinical study on carotid plaques suggested that eccentric plaque is a potential marker for ipsilateral cerebrovascular events. 4 Our present study on histology-verified ICAD, however, failed to indicate the association between eccentric intracranial atherosclerotic plaques and brain infarctions, in spite of seemingly higher incidence of brain infarction due to eccentric plaques rather than concentric plaques. Further studies are needed to clarify the morphological features of ICAD and to explore their clinical relevance.…”

Section: Discussioncontrasting

confidence: 39%

“…3 Recent clinical trial studies on carotid arteries showed that, in addition to luminal stenosis, plaque eccentricity (symmetry) is among the plaque features associated with more frequent cerebrovascular events. 4 The aim of the current study was to investigate the eccentricity of histology-verified intracranial atherosclerotic lesions on 1.5T MRI vessel wall imaging and its potential clinical implications. …”

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In Vitro Assessment of Histology Verified Intracranial Atherosclerotic Disease by 1.5T Magnetic Resonance Imaging

Yang

Chen

Zhao

et al. 2016

Stroke

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Intracranial atherosclerotic disease (ICAD), as a most common cause of ischemic stroke, has been drawing increased attentions of clinicians and researchers in the worldwide. 1 Advanced imaging techniques, especially High Resolution Magnetic Resonance Imaging (HRMRI), could visualize the pathology of intracranial arterial diseases.2 However, current knowledge about histology of intracranial atherosclerosis lags behind the development of updated imaging modalities due to lacking of vessel specimens. Our previous post-mortem study showed that both luminal stenosis and percentage of lipid area or intraplaque neovasculature may play a key role in leading to ischemic stroke. 3 Recent clinical trial studies on carotid arteries showed that, in addition to luminal stenosis, plaque eccentricity (symmetry) is among the plaque features associated with more frequent cerebrovascular events. 4 The aim of the current study was to investigate the eccentricity of histology-verified intracranial atherosclerotic lesions on 1.5T MRI vessel wall imaging and its potential clinical implications. Materials and Methods SpecimensWe recruited, consecutively, Chinese patients aged 45 years old or above, who died and underwent postmortem study at the Prince of Wales Hospital, Hong Kong (a regional general hospital) during a period of 19 months. The study was approved by the Clinical Research Ethics Committee of the Chinese University of Hong Kong. Among 58 elderly autopsy cases, 10 cases were excluded due to poor image quality (3 due to improper location of brain within the head coil, 3 due to inaccurate orientation of MRI scanning, 4 due to too large air rather than brain tissue which caused difficulties in acquiring proper imaging). Histology of middle cerebral arteries (MCAs) belonging to 10Background and Purpose-Clinical trial studies show that plaque eccentricity (symmetry) is among the plaque features that have been associated with more frequent cerebrovascular events. Plaque eccentricity of intracranial atherosclerotic disease is unclear because of lacking of cerebral artery specimens. Methods-1.5T magnetic resonance imaging was performed in the postmortem brains to scan the cross sections of middle cerebral artery. The whole brain was obtained fresh and intact during the process of autopsies. The MCAs were washed with water to clear the possible blot inside. Then the whole brain was fresh frozen at 4°C until imaged. The period between autopsy and imaging was less than 5 days. MRIThe MRI examinations of the brains were performed by a 1.5-T scanner (Sonata, Siemens Medical Systems, Erlangen, Germany) with a standard head coil (with 8 channels). To keep the arteries uncollapsed, diluted barium solution was injected into the lumen to distend the artery. Then the brains were positioned in the scanner to resemble a supine head first position in routine clinical scanning. The orientation of the MCA was localized by the TSE T2 sequence of the whole brain. An experienced radiologist would then choose an imaging plane perpendicular to each MCA...

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confidence: 39%

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In Vitro Assessment of Histology Verified Intracranial Atherosclerotic Disease by 1.5T Magnetic Resonance Imaging

Yang

Chen

Zhao

et al. 2016

Stroke

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“…Previous studies showed that for carotid plaques, larger maximum wall thickness and eccentric plaques were associated with the occurrence of subsequent cerebrovascular events1617. For intracranial vascular disease, eccentric wall thickening has been used to distinguish intracranial atherosclerosis from other etiologies1819.…”

Section: Discussionmentioning

confidence: 99%

Vessel wall differences between middle cerebral artery and basilar artery plaques on magnetic resonance imaging

Niu

Zhou

et al. 2016

Sci Rep

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A recent study showed that posterior circulation plaques have a greater capacity for positive remodeling in a non-Asian population. We aimed to investigate if the features of plaques in the middle cerebral artery (MCA) were different from those in the basilar artery (BA) in a northern Chinese population. We retrospectively analysed the records of 71 consecutive patients with acute ischemic stroke. All patients had at least one MCA or BA plaque with early or mild (<50% stenosis) atherosclerosis identified using vessel wall magnetic resonance imaging. The remodeling ratio, eccentricity index, and plaque range were compared between MCA and BA plaques using multilevel analysis. A total of 101 plaques were included. There were 70 plaques located in the MCA and 31 plaques located in the BA. The features of non-advanced atherosclerotic plaques did not differ between the MCA and BA when accounting for the degree of stenosis or plaque burden in a northern Chinese population. Symptomatic plaques were associated with a higher eccentricity index and smaller plaque range than asymptomatic plaques under the same plaque burden. Further studies are warranted to investigate the progression of atherosclerosis in different intracranial arteries.Intracranial atherosclerotic disease is one of the important causes of ischemic stroke or transient ischemic attack, especially in Asian, Hispanic and African populations 1,2 . Recently, with the rapid development of vessel wall magnetic resonance imaging (VWMRI) techniques, there has been increasing interest in studies of intracranial atherosclerosis. The use of VWMRI has greatly improved the understanding of the pathophysiology of atherosclerosis 3 . The plaque features on VWMRI may be important predictors of stroke and were shown to correlate with pathological findings [4][5][6][7][8] . Atherosclerosis is a systemic disease that may involve several vascular beds, including coronary, peripheral, and renal arteries in addition to the cerebral arteries. However, a previous study showed that the carotid artery has a pattern of remodeling that was distinct from that of the femoral artery, which may be caused by differences in anatomy and blood flow 9 . A recently study also showed that there was a significant difference in arterial remodeling between the arteries of the intracranial posterior circulation and intracranial anterior circulation in a Western population 10 . We aimed to investigate if the features of plaques of the middle cerebral artery (MCA) were different from those of the basilar artery (BA) in the early and intermediate stages of atherosclerosis in a northern Chinese population. ResultsA total of 71 patients with 101 plaques were included in this study. There were 70 plaques located in the MCA and 31 plaques located in the BA. Among the 70 MCA plaques, 20 were classified as symptomatic, 6 were indeterminate, and 44 were asymptomatic. Among the 31 BA plaques, 11 were symptomatic, 12 were indeterminate, and 8 were asymptomatic (chi-squared test, P for trend = 0.022). Table 1 sh...

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“…TVA, LA, and WA reflect the severity of carotid atherosclerosis in outward remodeling, lumen reduction, and plaque burden [20]. Luminal Max-stenosis remains the main indictor for assessing the clinical risk from carotid atherosclerotic disease [21]. Recent studies have shown that NWI measurement may more accurately present the severity of carotid atherosclerosis [22].…”

Section: Discussionmentioning

confidence: 99%

Comparison of carotid arterial morphology and plaque composition between patients with acute coronary syndrome and stable coronary artery disease: a high-resolution magnetic resonance imaging study

Wang

Zeng

Wang

et al. 2011

Int J Cardiovasc Imaging

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The purpose of this study was to evaluate the differences in carotid arterial morphology and plaque composition between patients with acute coronary syndrome (ACS) and patients with stable coronary artery disease (SCAD). Twenty-eight patients (12 ACS patients and 16 SCAD patients) underwent carotid high-resolution MRI examination using a 3.0-Tesla (3.0T) MRI scanner. The indicators of carotid arterial morphology included the maximum total vessel area (Max-TVA), mean TVA, minimum lumen area (Min-LA), mean LA, maximum wall area (Max-WA), mean WA, maximum wall thickness (Max-WT), mean WT, maximum normalized wall index (Max-NWI), mean NWI, and maximum stenosis (Max-stenosis). The indicators of plaque composition included the prevalence and mean area percentage (%) of lipid-rich necrotic core (LRNC), calcification (Ca), intraplaque hemorrhage (IPH), and fibrous cap rupture (FCR). None of the indicators of carotid arterial morphology had significant differences (all P > 0.05) between the ACS and SCAD patients. The prevalence and plaque composition area percentage of LRNC, Ca, and IPH did not exhibit significant differences between the two groups. However, carotid plaques in the ACS patients presented a higher prevalence of FCR than SCAD patients (P < 0.05). This study revealed a similar carotid arterial morphology between ACS and SCAD patients. However, FCR is more common in carotid plaques with ACS than in those with SCAD. Ruptured carotid plaques may be a forewarning factor for those patients who are at high risk of ACS.

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Eccentric Stenosis of the Carotid Artery Associated with Ipsilateral Cerebrovascular Events

Abstract: BACKGROUND AND PURPOSE:Eccentric stenosis of the coronary artery is associated with plaque disruption and acute coronary syndrome. The purpose of the present study was to determine whether eccentric stenosis of the carotid artery contributes to cerebrovascular events.

Cited by 57 publications

References 35 publications

In Vitro Assessment of Histology Verified Intracranial Atherosclerotic Disease by 1.5T Magnetic Resonance Imaging

In Vitro Assessment of Histology Verified Intracranial Atherosclerotic Disease by 1.5T Magnetic Resonance Imaging

Vessel wall differences between middle cerebral artery and basilar artery plaques on magnetic resonance imaging

Comparison of carotid arterial morphology and plaque composition between patients with acute coronary syndrome and stable coronary artery disease: a high-resolution magnetic resonance imaging study

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