High-risk carotid plaques identified by CT-angiogram can predict acute myocardial infarction

Abstract

Purpose Prior studies identified the incremental value of non-invasive imaging by CT-angiogram (CTA) to detect high-risk coronary atherosclerotic plaques. Due to their superficial locations, larger calibers and motion-free imaging, the carotid arteries provide the best anatomic access for the non-invasive characterization of atherosclerotic plaques. We aim to assess the ability of predicting obstructive coronary artery disease (CAD) or acute myocardial infarction (MI) based on high-risk carotid plaque features identified by CTA. Methods We retrospectively examined carotid CTAs of 492 patients that presented with acute stroke to characterize the atherosclerotic plaques of the carotid arteries and examined development of acute MI and obstructive CAD within 12-months. Carotid lesions were defined in terms of calcifications (large or speckled), presence of low-attenuation plaques, positive remodeling, and presence of napkin ring sign (NRS). Adjusted relative risks were calculated for each plaque features. Results Patients with speckled (<3mm) calcifications and/or larger calcifications on CTA had a higher risk of developing an MI and/or obstructive CAD within one year compared to patients without [adjusted RR of 7.51, 95%CI 1.26 to 73.42, P= 0.001]. Patients with low-attenuation plaques on CTA had a higher risk of developing an MI and/or obstructive CAD within one year than patients without [adjusted RR of 2.73, 95%CI 1.19 to 8.50, P= 0.021]. Presence of carotid calcifications and low-attenuation plaques also portended higher sensitivity (100% and 79.17%, respectively) for the development of acute MI. Conclusions Presence of carotid calcifications and low-attenuation plaques can predict the risk of developing acute MI and/or obstructive CAD within 12-months. Given their high sensitivity, their absence can reliably exclude 12-month events.

Superficial and multiple calcifications and ulceration associate with intraplaque hemorrhage in the carotid atherosclerotic plaque

“…The degree of luminal stenosis, plaque thickness, surface ulceration and remodeling index (RI = the maximum wall thickness at the most stenotic site/the wall thickness at the nearby disease-free site) were calculated or identified. Positive soft plaque was defined as maximum soft plaque thickness >2 mm [ 25 ], and a positive remodeling index was reported as RI ≥ 1.1 [ 26 ]. The mean plaque Hounsfield unit (HU) was defined as the average HU in the region between the lumen and outer wall contour across the whole plaque volume [ 27 ].…”

Carotid arteries and vertebrobasilary system intracranial stenosis correlates with multi vessel coronary artery disease

“…CTA can establish plaque stenosis rates as accurately as conventional digital substraction angiography (DSA). CTA is generally preferred over DSA, because CTA is noninvasive and can depict vascular wall pathologies, plaque morphology, and extravascular tissues in addition to the vascular lumen (14,15). CTA scans provide vital information to the clinician, as the rate of carotid stenosis and the nature of the atherothrombotic plaque play an important role in determining the course of treatment (15,16).…”

Relationship between Carotid Computed Tomography Dual-Energy and Brain Leukoaraiosis

“…In particular, the presence of iodine in the plaque is mainly due to neovascularization, 23,24 and it could be associated with an increased, systemic atherosclerotic activity as demonstrated in a recent published study that demonstrated the association between carotid plaque features and increased risk of myocardial infarction. 25 Following this hypothesis, the presence of atherosclerotic disease, with plaques that show contrast (detected with the keV variation), could be considered as a surrogate marker of LA.…”