Normalized wall index, intraplaque hemorrhage and ulceration of carotid plaques correlate with the severity of ischemic stroke

Cao, Xin; Yang, Qin; Tang, Ye; Pan, Lei; Lai, Mao; Yu, Zekuan; Geng, Daoying; Zhang, Jun

doi:10.1016/j.atherosclerosis.2020.10.896

Cited by 20 publications

(11 citation statements)

References 52 publications

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“…First, the present study found that SF and sTfR in serum were positively correlated with NWI (structural features of vulnerable plaques). It has been noted in the literature that the severity of NWI significantly correlates with the volume loading of carotid plaque and is a better indicator of the severity of atherosclerotic disease than the degree of stenosis [24,25]. Second, the expression of H-FT, L-FT, and TfR1 in plaque was positively correlated with LRNC volume, a component characteristic of vulnerable plaques.…”

Section: Discussionmentioning

confidence: 90%

The Relation of the Iron Metabolism Index to the Vulnerability Index of Carotid Plaque with Different Degrees of Stenosis

Yuan,

Huo,

Hou

et al. 2023

Diagnostics

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Objective: To investigate the differences in serum iron index and iron metabolizing protein expression in plaques in patients with different degrees of carotid artery stenosis and the relationship with plaque traits. Methods: A total of 100 patients eligible for carotid endarterectomy (CEA) from August 2021 to February 2022 were included. Patients completed a computed tomography (CTA) scan for patient grouping and a magnetic resonance imaging (MRI) for precise quantification of carotid plaque traits within 1 week prior to surgery. Clinical indicators associated with the progression of carotid stenosis to occlusion were analyzed using ordered logistic regression. Twenty carotid plaques were analyzed immunohistochemically to investigate the relationship between plaque traits and the iron metabolism indexes. Results: No significant correlation between high serum ferritin (SF), unsaturated iron binding capacity (UIBC) and progression of carotid stenosis (OR 1.100, 95% CI 0.004–0.165, p = 0.039; OR 1.050, 95% CI 0.005–0.094, p = 0.031). SF and serum transferrin receptor (sTfR) were correlated with normalized wall index (NWI) (R = 0.470, p = 0.036; R = 0.449, p = 0.046), and the results of multiple linear regression suggested that SF and sTfR remained associated with NWI (R = 0.630, R2 = 0.397, Adjusted R2 = 0.326, p = 0.014). In plaques, H-type ferritin (H-FT) was correlated with NWI and lipid-rich necrotic core (LRNC) volume (R = 0.502, p = 0.028; R = 0.468, p = 0.043). Transferrin receptor 1 (TfR1) was correlated with LRNC volume and intraplaque hemorrhage (IPH) volume (R = 0.538, p = 0.017; R = 0.707, p = 0.001). Conclusions: There were statistical differences in the expression of iron metabolism proteins in carotid plaques with different degrees of stenosis. Serum iron metabolism index (SF and sTfR) and expression of iron metabolizing proteins (H-FT and TfR1) in plaques were positively correlated with carotid plaque vulnerability index (NWI, LRNC volume).

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Section: Discussionmentioning

confidence: 90%

The Relation of the Iron Metabolism Index to the Vulnerability Index of Carotid Plaque with Different Degrees of Stenosis

Yuan,

Huo,

Hou

et al. 2023

Diagnostics

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“…The slice with the largest plaque area was chosen, and the outer wall boundaries and inner lumen were manually outlined for measuring and calculating the total vessel area (TVA), the minimum luminal area (Min LA), the maximum wall area (Max WA), the normalized wall index (NWI), the remodeling index (RI), and the degree of stenosis. The relevant calculation formulas were as follows: (1) Max WA = TVA-Min LA ( 17 ); (2) NWI = Max WA/TVA ( 18 , 19 ); (3) RI = vessel area at the point of maximum stenosis/reference vessel area at the distal portion ( 7 ); (4) Stenosis = (normal diameter at the distal portion-narrowest diameter at the stenosis)/normal diameter at the distal portion ( 20 ). If the RI is greater than 1, it is defined as positive remodeling; otherwise, it is defined as negative remodeling.…”

Section: Methodsmentioning

confidence: 99%

A clinical-radiomics combined model based on carotid atherosclerotic plaque for prediction of ischemic stroke

Han,

Hu,

et al. 2024

Front. Neurol.

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ObjectivesTo accurately predict the risk of ischemic stroke, we established a radiomics model of carotid atherosclerotic plaque-based high-resolution vessel wall magnetic resonance imaging (HR-VWMRI) and combined it with clinical indicators.Materials and methodsIn total, 127 patients were finally enrolled and randomly divided into training and test cohorts. HR-VWMRI three-dimensional T1-weighted imaging (T1WI) and contrast-enhanced T1WI (T1CE) were collected. A traditional model was built by recording and calculating radiographic features of the carotid plaques and patients’ clinical indicators. After extracting radiomics features from T1WI and T1CE images, the least absolute shrinkage and selection operator (LASSO) algorithm was used to select the optimal features and construct the radiomics_T1WI model and the radiomics_T1CE model. The traditional and radiomics features were used to build combined models. The performance of all the models predicting ischemic stroke was evaluated in the training and test cohorts, respectively.ResultsBody mass index (BMI) and intraplaque hemorrhage (IPH) were independently related to ischemic stroke and were used to build the traditional model, which achieved an area under the curve (AUC) of 0.79 versus 0.78 in the training and test cohorts, respectively. The AUC value of the radiomics_T1WI model is the lowest in the training and test cohorts, but the prediction performance is significantly improved when the model combines IPH and BMI. The AUC value of the combined_T1WI model was 0.78 and 0.81 in the training and test cohorts, respectively. In addition, in the training and test cohorts, the radiomics_T1CE model based on HR-VWMRI combined clinical characteristics, which is the combined_T1CE model, had the highest AUC value of 0.84 and 0.82, respectively.ConclusionCompared with other models, the radiomics_T1CE model based on HR-VWMRI combined clinical characteristics, which is a combined_T1CE model, can accurately predict the risk of ischemic stroke.

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“…1 . The normalized wall index (NWI) was calculated as WA lesion / OWA lesion ×100% [ 35 ]. The arterial remodeling ratio (ARR) was calculated as (OWA lesion / OWA reference ) ×100% (Fig.…”

Section: Methodsmentioning

confidence: 99%

The incomplete circle of Willis is associated with vulnerable intracranial plaque features and acute ischemic stroke

Wang

Shen

Zhao

et al. 2023

Journal of Cardiovascular Magnetic Resonance

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Background The circle of Willis (CoW) plays a significant role in intracranial atherosclerosis (ICAS). This study investigated the relationship between different types of CoW, atherosclerosis plaque features, and acute ischemic stroke (AIS). Methods We investigated 97 participants with AIS or transient ischemic attacks (TIA) underwent pre- and post-contrast 3T vessel wall cardiovascular magnetic resonance within 7 days of the onset of symptoms. The culprit plaque characteristics (including enhancement grade, enhancement ratio, high signal in T1, irregularity of plaque surface, and normalized wall index), and vessel remodeling (including arterial remodeling ratio and positive remodeling) for lesions were evaluated. The anatomic structures of the anterior and the posterior sections of the CoW (A-CoW and P-CoW) were also evaluated. The plaque features were compared among them. The plaque features were also compared between AIS and TIA patients. Finally, univariate and multivariate regression analysis was performed to evaluate the independent risk factors for AIS. Result Patients with incomplete A-CoW showed a higher plaque enhancement ratio (P = 0.002), enhancement grade (P = 0.01), and normalized wall index (NWI) (P = 0.018) compared with the patients with complete A-CoW. A higher proportion of patients with incomplete symptomatic P-CoW demonstrated more culprit plaques with high T1 signals (HT1S) compared with those with complete P-CoW (P = 0.013). Incomplete A-CoW was associated with a higher enhancement grade of the culprit plaques [odds ratio (OR):3.84; 95% CI: 1.36–10.88, P = 0.011], after adjusting for clinical risk factors such as age, sex, smoking, hypertension, hyperlipemia, and diabetes mellitus. Incomplete symptomatic P-CoW was associated with a higher probability of HT1S (OR:3.88; 95% CI: 1.12–13.47, P = 0.033), after adjusting for clinical risk factors such as age, sex, smoking, hypertension, hyperlipemia, and diabetes mellitus. Furthermore, an irregularity of the plaque surface (OR: 6.24; 95% CI: 2.25–17.37, P < 0.001), and incomplete symptomatic P-CoW (OR: 8.03, 95% CI: 2.43–26.55, P = 0.001) were independently associated with AIS. Conclusions This study demonstrated that incomplete A-CoW was associated with enhancement grade of the culprit plaque, and incomplete symptomatic side P-CoW was associated with the presence of HT1S of culprit plaque. Furthermore, an irregularity of plaque surface and incomplete symptomatic side P-CoW were associated with AIS.

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Normalized wall index, intraplaque hemorrhage and ulceration of carotid plaques correlate with the severity of ischemic stroke

Cited by 20 publications

References 52 publications

The Relation of the Iron Metabolism Index to the Vulnerability Index of Carotid Plaque with Different Degrees of Stenosis

The Relation of the Iron Metabolism Index to the Vulnerability Index of Carotid Plaque with Different Degrees of Stenosis

A clinical-radiomics combined model based on carotid atherosclerotic plaque for prediction of ischemic stroke

The incomplete circle of Willis is associated with vulnerable intracranial plaque features and acute ischemic stroke

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