Prediction of Stroke Risk by Detection of Hemorrhage in Carotid Plaques

Schindler, Andreas; Schinner, Regina; Altaf, N.; Hosseini, Akram A.; Simpson, Richard; Esposito-Bauer, Lorena; Singh, Navneet; Kwee, Robert M.; Kurosaki, Yoshitaka; Yamagata, Sen; Yoshida, Kazumichi; Miyamoto, Susumu; Maggisano, Robert; Moody, Alan R.; Poppert, Holger; Kooi, M. Eline; Auer, Dorothee P.; Bonati, Leo H.; Saam, Tobias

doi:10.1016/j.jcmg.2019.03.028

Cited by 160 publications

(156 citation statements)

References 40 publications

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“…Yamada et al [14] found that, at 24-month follow-up, 29% of patients with the presence of IPH had strokes, whereas no patients experienced a stroke without the presence of IPH. Schindler et al [15] found IPH to be a stronger predictor of ipsilateral stroke than any of the studied clinical risk factors. Symptomatic patients with >70% carotid stenosis IPH were found to have an annual stroke risk rate of 29.0% as compared to a 1.5% annual risk in patients without IPH with >70% stenosis.…”

Section: Discussionmentioning

confidence: 99%

Carotid Intraplaque Hemorrhage Is Associated with Cardiovascular Risk Factors

et al. 2020

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Introduction: Intraplaque hemorrhage (IPH) is a known predictor of symptomatic cervical carotid artery disease. However, the association between IPH and modifiable cardiovascular risk factors, patient demographics, and pertinent laboratory values has not been extensively studied. Methods: A retrospective review was performed of consecutive patients who have undergone dedicated carotid plaque imaging over a 3-year period. Patients were excluded if the MR examination did not include high-resolution carotid plaque imaging. Intraplaque hyperintense signal on carotid plaque images was presumed to represent IPH. The presence or absence of IPH was compared to various demographic and clinical variables. Multivariable regression analysis was performed in order to determine an independent association between variables and IPH. Results: Of 643 included patients, 114 patients (17.7%) had IPH in one or both carotids, 529 patients (82.3%) did not; 39.5% of patients with IPH had coronary artery disease compared to 23.1% of patients without (p = 0.0003). Patients with IPH also had higher proportions of hypertension (77.2 vs. 60.7%, p = 0.009), hyperlipid-emia (HLD; 89.5 vs. 62.4%, p < 0.0001), diabetes mellitus (29.0 vs. 18.7%, p = 0.01), and a history of tobacco smoking (63.2 vs. 52.6%, p = 0.003). Patients without IPH had, on average, higher high-density lipoprotein levels (46.1 vs. 56.7%, p = 0.003). Factors independently associated with IPH were advanced age (odds ratio [OR]: 1.1, 95% CI: [1.0-1.05], p < 0.0001), male sex (OR: 2.5, 95% CI: [1.4-4.4], p = 0.0001), presence of carotid stenosis (OR: 8.4, 95% CI: [4.6-15.3], p < 0.0001), and HLD (OR: 2.6, 95% CI: [1.3-5.2], p = 0.009). Conclusions: IPH is associated with multiple cardiovascular risk factors, in particular advanced age, male sex, presence of carotid stenosis, and HLD. Such risk factors likely play a role in the development of IPH and may provide insight into the pathophysiology of unstable carotid plaques.

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Section: Discussionmentioning

confidence: 99%

Carotid Intraplaque Hemorrhage Is Associated with Cardiovascular Risk Factors

et al. 2020

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“…[ 32 33 34 ] Likewise, carotid intraplaque hemorrhage (IPH) was also demonstrated to be a significant predictor of stroke beyond clinical risk factors and may help tailoring treatments to patients with CAS. [ 35 ] Recent advances in technology have revolutionized in vivo imaging techniques, and the emergence of T2 mapping MRI technique would enable us, with a high degree of accuracy, to early characterize carotid atherosclerotic plaques. [ 21 ]…”

Section: Current Challenges In the Management Of Carotid Diseasementioning

confidence: 99%

“…[ 47 ] Nevertheless, IPH was a strong predictor of stroke in patients with CAS beyond any other clinical risk factors. [ 48 ] While IPH was present more frequently in patients with symptomatic CAS, the association with stroke was evident irrespective of the symptomatic status of the carotid plaque. [ 48 ]…”

Section: The Role Of Other High-risk Atherosclerotic Plaque Features mentioning

confidence: 99%

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A promising tool to tackle the risk of cerebral vascular disease, the emergence of novel carotid wall imaging

Alkhalil

2020

Brain Circ

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Stroke is a heterogeneous vascular disease. Carotid artery atherosclerosis is associated with almost one-quarter of ischemic strokes. Moreover, a large percentage of preventable strokes are currently attributed to carotid atherosclerosis. Over the past three decades, the management of carotid artery disease has evolved. The benefits of carotid revascularization alongside medical therapy have early been recognized. Nonetheless, the debate regarding the optimal strategy is still ongoing, particularly in patients with asymptomatic carotid artery disease. One of the challenges is the use of luminal stenosis to quantify the severity of the carotid artery disease and to guide decision-making regarding invasive revascularization. Characterizing carotid atherosclerotic plaque is a promising tool to identify vulnerable plaque. Certain features such as large lipid core have already been linked to acute vascular events, not only at the plaque level but also to predict systemic cardiovascular events. Recently, a quantitative T2 mapping magnetic resonance imaging technique was developed and validated against histology. The ability to accurately quantify plaque lipid content using this technique opens several new opportunities. In this review articles, we will discuss the current challenges in the management of carotid artery disease and the future roles of T2 mapping to aid therapeutic options. These roles may include how to determine the mode of invasive carotid revascularization in symptomatic patients. Moreover, there may be a rational to use T2 mapping as a risk stratification tool in asymptomatic patients with carotid artery stenosis. It may also provide an opportunity to stage atherosclerosis and identify patients with coronary atherosclerosis who may benefit maximally from intensive lipid interventions.

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“…With advances in carotid plaque imaging, various plaque characteristics such as intraplaque hemorrhage (IPH), lipid rich necrotic core and inflammation have become increasingly recognized as features of plaque vulnerability (2). IPH, in particular, is a strong predictor of future cerebral ischemic events independent of carotid stenosis or ischemic symptoms (3)(4)(5). It is therefore important to be able to recognize which patients may be at risk for IPH so that appropriate intervention may be pursued.…”

Section: Introductionmentioning

confidence: 99%

Variations in the Presence of Carotid Intraplaque Hemorrhage Across Age Categories: What Age Groups Are Most Likely to Benefit From Plaque Imaging?

et al. 2020

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Although carotid artery intraplaque hemorrhage (IPH) is a known risk-factor for cerebral ischemic events in patients of advanced age, its prevalence in younger cohorts is less certain. The purpose of this study was to assess the prevalence of carotid artery IPH across the age spectrum. A retrospective review was completed of all adult patients from our institution who underwent neck MRA with high-resolution carotid plaque imaging between 2017 and 2020. The mean ages of patients with and without IPH were calculated. The prevalence of IPH was compared between patients that were categorized into age groups. Patients with and without a cerebral ischemic event (e.g., stroke, retinal ischemia) were included. Unilateral anterior circulation ischemic events in patients without atrial fibrillation were presumed to be likely related to ipsilateral carotid artery disease. Multiple regression analysis was performed to determine independent associations with IPH. 634 patients were included (1,268 carotid arteries). Increasing age (OR: 1.04; 95% CI: 1.02–1.06; P = 0.001) was independently associated with IPH. 211 patients had unilateral anterior circulation ischemic events. The mean age of patients with carotid IPH was 71.4 years (SD = 9.9), compared to 62.8 years (SD = 15.8) of those without (P ≤ 0.0001). The prevalence of IPH increased with age in all patients (P = 0.0002). Among patients with ipsilateral anterior circulation ischemic events, each age category above 50 years had a significantly higher prevalence of IPH when compared to patients 18–50 years (P ≤ 0.05 for all comparisons). The prevalence of carotid IPH increases with age and is rare in patients under 50 years. The approximate threshold age for IPH development is likely around 50 years.

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Prediction of Stroke Risk by Detection of Hemorrhage in Carotid Plaques

Cited by 160 publications

References 40 publications

Carotid Intraplaque Hemorrhage Is Associated with Cardiovascular Risk Factors

Carotid Intraplaque Hemorrhage Is Associated with Cardiovascular Risk Factors

A promising tool to tackle the risk of cerebral vascular disease, the emergence of novel carotid wall imaging

Variations in the Presence of Carotid Intraplaque Hemorrhage Across Age Categories: What Age Groups Are Most Likely to Benefit From Plaque Imaging?

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