Magnetic Resonance Detected Carotid Plaque Hemorrhage is Associated With Inflammatory Features in Symptomatic Carotid Plaques

Altaf, Nishath; Akwei, Solomon; Auer, Dorothee P.; MacSweeney, Shane T.; Lowe, James

doi:10.1016/j.avsg.2012.10.011

Cited by 15 publications

(12 citation statements)

References 28 publications

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“…This notion is supported by the relationship between carotid MRIPH and the presence of ipsilateral cerebral ischemic lesion burden, microembolic signals during CEA, and recurrent recent embolic events as detected by multiple white matter diffusion abnormalities as well as spontaneous microembolic signals . Moreover, 3‐dimensional, T1‐weighted, blood‐ and fat‐nulled MRI has been histologically qualified to accurately detect plaque hemorrhage in our sample and by others, with sensitivity of 91 to 100% and specificity of 77 to 80%, meeting some key biomarker requirements.…”

Section: Discussionsupporting

confidence: 81%

“…Recently developed dedicated magnetic resonance imaging (MRI) techniques allow characterization of these features, of which intraplaque hemorrhage (PH) is the most widely studied imaging marker. Based on typical MRI characteristics of blood products, PH can be reliably identified in both multicontrast and single T1‐weighted MRI scans that depict PH as distinct intraplaque hyperintensity …”

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confidence: 99%

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Carotid plaque hemorrhage on magnetic resonance imaging strongly predicts recurrent ischemia and stroke

Hosseini

Kandiyil

MacSweeney

et al. 2013

Annals of Neurology

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164

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ObjectiveThere is a recognized need to improve selection of patients with carotid artery stenosis for carotid endarterectomy (CEA). We assessed the value of magnetic resonance imaging (MRI)-defined carotid plaque hemorrhage (MRIPH) to predict recurrent ipsilateral cerebral ischemic events, and stroke in symptomatic carotid stenosis.MethodsOne hundred seventy-nine symptomatic patients with ≥50% stenosis were prospectively recruited, underwent carotid MRI, and were clinically followed up until CEA, death, or ischemic event. MRIPH was diagnosed if the plaque signal intensity was >150% that of the adjacent muscle. Event-free survival analysis was done using Kaplan–Meier plots and Cox regression models controlling for known vascular risk factors. We also undertook a meta-analysis of reported data on MRIPH and recurrent events.ResultsOne hundred fourteen patients (63.7%) showed MRIPH, suffering 92% (57 of 62) of all recurrent ipsilateral events and all but 1 (25 of 26) future strokes. Patients without MRIPH had an estimated annual absolute stroke risk of only 0.6%. Cox multivariate regression analysis proved MRIPH as a strong predictor of recurrent ischemic events (hazard ratio [HR] = 12.0, 95% confidence interval [CI] = 4.8–30.1, p < 0.001) and stroke alone (HR = 35.0, 95% CI = 4.7–261.6, p = 0.001). Meta-analysis of published data confirmed this association between MRIPH and recurrent cerebral ischemic events in symptomatic carotid artery stenosis (odds ratio = 12.2, 95% CI = 5.5–27.1, p < 0.00001).InterpretationMRIPH independently and strongly predicts recurrent ipsilateral ischemic events, and stroke alone, in symptomatic ≥50% carotid artery stenosis. The very low stroke risk in patients without MRIPH puts into question current risk–benefit assessment for CEA in this subgroup. ANN NEUROL 2013;73:774–784

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Section: Discussionsupporting

confidence: 81%

mentioning

confidence: 99%

Carotid plaque hemorrhage on magnetic resonance imaging strongly predicts recurrent ischemia and stroke

Hosseini

Kandiyil

MacSweeney

et al. 2013

Annals of Neurology

Self Cite

164

120

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“…The biomechanical forces acting on a plaque, which is weakened structurally by the underlying inflammation driven by agents like PH (Altaf et al, 2013), can trigger plaque rupture due to excess loading on the thin FC. Although this remains a hypothesis, circumstantial evidence supports this mechanism.…”

Section: Local Biomechanical Stresses and Carotid Plaque Hemorrhagementioning

confidence: 99%

Plaque hemorrhage in carotid artery disease: Pathogenesis, clinical and biomechanical considerations

Zhang

Sadat

Brown

et al. 2014

Journal of Biomechanics

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Stroke remains the most prevalent disabling illness today, with internal carotid artery luminal stenosis due to atheroma formation responsible for the majority of ischemic cerebrovascular events. Severity of luminal stenosis continues to dictate both patient risk stratification and the likelihood of surgical intervention. But there is growing evidence to suggest that plaque morphology may help improve pre-existing risk stratification criteria. Plaque components such a fibrous tissue, lipid rich necrotic core and calcium have been well investigated but plaque hemorrhage (PH) has been somewhat overlooked. In this review we discuss the pathogenesis of PH, its role in dictating plaque vulnerability, PH imaging techniques, marterial properties of atherosclerotic tissues, in particular, those obtained based on in vivo measurements and effect of PH in modulating local biomechanics.

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“…[4][5][6] One such component of carotid plaque that has been identified as a component of advanced atherosclerotic lesions is intraplaque hemorrhage (IPH). When present in carotid atherosclerotic plaque, IPH has been associated with previous 7,8 and future 9 stroke and has been proposed as a possible marker of not only plaque inflammation 10 but also of generalized cardiovascular risk.…”

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confidence: 99%

Intraplaque High-Intensity Signal on 3D Time-of-Flight MR Angiography Is Strongly Associated with Symptomatic Carotid Artery Stenosis

Gupta¹,

Baradaran²,

Kamel³

et al. 2013

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Intraplaque hemorrhage in carotid artery atherosclerotic plaque has been shown to be a marker of risk, associated with prior and future ischemic events, and has been associated with regions of intraplaque high-intensity signal on 3D-TOF MRA.We assessed the association of intraplaque high-intensity signal determined on 3D-TOF MRA with the incidence of prior ipsilateral stroke or TIA.

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Magnetic Resonance Detected Carotid Plaque Hemorrhage is Associated With Inflammatory Features in Symptomatic Carotid Plaques

Cited by 15 publications

References 28 publications

Carotid plaque hemorrhage on magnetic resonance imaging strongly predicts recurrent ischemia and stroke

Carotid plaque hemorrhage on magnetic resonance imaging strongly predicts recurrent ischemia and stroke

Plaque hemorrhage in carotid artery disease: Pathogenesis, clinical and biomechanical considerations

Intraplaque High-Intensity Signal on 3D Time-of-Flight MR Angiography Is Strongly Associated with Symptomatic Carotid Artery Stenosis

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