Size of carotid artery intraplaque hemorrhage and acute ischemic stroke: a cardiovascular magnetic resonance Chinese atherosclerosis risk evaluation study

Liu, Yang; Wang, Maoxue; Zhang, Bing; Wang, Wei; Xu, Yun; Han, Yongjun; Yuan, Chun; Zhao, Xihai

doi:10.1186/s12968-019-0548-1

Cited by 37 publications

(24 citation statements)

References 27 publications

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“…These findings confirm that IPH volume is higher in plaques causing cerebrovascular events. 2,3,5,6,31,32 Of interest, there was no difference in lipid-IPH volume tissue, whereas the total lipid volume showed a statistically significant difference. This finding can be explained because in the old classification the lipid volume class included all the voxels <60 HU (and therefore also the IPH component); these results suggest that tissues with an attenuation between 26 to 59 HU, namely fatty components, are not associated with the presence of cerebrovascular events.…”

Section: Discussionmentioning

confidence: 83%

Carotid Intraplaque-Hemorrhage Volume and Its Association with Cerebrovascular Events

Saba¹,

Micheletti²,

Brinjikji

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Our aim was to assess the relationship between volume and percentage of intraplaque hemorrhage measured using CT and the occurrence of cerebrovascular events at the time of CT. MATERIALS AND METHODS: One-hundred-twenty-three consecutive subjects (246 carotid arteries) with a mean age of 69 years who underwent CTA were included in this retrospective study. Plaque volume of components and subcomponents (including intraplaque hemorrhage volume) was quantified with dedicated software.

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Section: Discussionmentioning

confidence: 83%

Carotid Intraplaque-Hemorrhage Volume and Its Association with Cerebrovascular Events

Saba¹,

Micheletti²,

Brinjikji

et al. 2019

AJNR Am J Neuroradiol

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“…Carotid plaque burden was significantly associated with ipsilateral acute cerebral infarction volume independent of the degree of carotid stenosis (115). Recently Liu et al showed that carotid plaque burden in patients with ≥1.5 mm carotid plaques was associated with the presence of acute stroke (116). Based on numerous ultrasound studies, it is well known that plaque burden is a better parameter for risk prediction than measurement of the common carotid artery intima-media thickness (73).…”

Section: Cross-sectional Studiesmentioning

confidence: 99%

Magnetic resonance imaging of carotid plaques: current status and clinical perspectives

Kassem¹,

Florea²,

Mottaghy³

et al. 2020

Ann Transl Med

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Rupture of a vulnerable carotid plaque is one of the leading causes of stroke. Carotid magnetic resonance imaging (MRI) is able to visualize all the main hallmarks of plaque vulnerability. Various MRI sequences have been developed in the last two decades to quantify carotid plaque burden and composition.Often, a combination of multiple sequences is used. These MRI techniques have been extensively validated with histological analysis of carotid endarterectomy specimens. High agreement between the MRI and histological measures of plaque burden, intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), fibrous cap (FC) status, inflammation and neovascularization has been demonstrated. Novel MRI sequences allow to generate three-dimensional isotropic images with a large longitudinal coverage. Other new sequences can acquire multiple contrasts using a single sequence leading to a tremendous reduction in scan time. IPH can be easily identified as a hyperintense signal in the bulk of the plaque on strongly T 1weighted images, such as magnetization-prepared rapid acquisition gradient echo images, acquired within a few minutes with a standard neurovascular coil. Carotid MRI can also be used to evaluate treatment effects.Several meta-analyses have demonstrated a strong predictive value of IPH, LRNC, thinning or rupture of the FC for ischemic cerebrovascular events. Recently, in a large meta-analysis based on individual patient data of asymptomatic and symptomatic individuals with carotid artery stenosis, it was shown that IPH on MRI is an independent risk predictor for stroke, stronger than any known clinical risk parameter. Expert recommendations on carotid plaque MRI protocols have recently been described in a white paper. The present review provides an overview of the current status and applications of carotid plaque MR imaging and its future potential in daily clinical practice.

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“…In the present study, the presence of LRNC and maximum area percentage of IPH were negatively correlated with the DR CBF but the correlation was weak. A study by Liu et al demonstrated that the size of IPH increased the risk of acute cerebral infarct 29 . Impaired microcirculation in carotid stenotic patients with LRNC might partially account for the smaller improvement of CBF after removing the plaques.…”

Section: Discussionmentioning

confidence: 99%

Associations Between Carotid Plaque Characteristics and Improvement of Cerebral Blood Perfusion in Patients With Moderate to Severe Carotid Stenosis Undergoing Carotid Endarterectomy

Huo

Yang

et al. 2020

Magnetic Resonance Imaging

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BackgroundThe relationship between plaque characteristics and their predictive value for perioperative cerebral blood flow (CBF) are unknown.PurposeTo investigate the relationship between carotid plaque characteristics and perioperative CBF utilizing MRI.Study TypeProspective.PopulationIn all, 131 patients with carotid moderate‐to‐severe stenosis referred for carotid endarterectomy (CEA).Field Strength/Sequence3T, black‐blood T1‐ and T2‐weighted, 3D time‐of‐flight, and simultaneous noncontrast angiography intraplaque hemorrhage.AssessmentThe relative CBF (rCBF = CBFindex‐hemisphere/CBFcontralateral‐hemisphere) and the CBF difference ratio (DRCBF = [CBFpost‐CEA – CBFpre‐CEA]/CBFpre‐CEA) in the middle cerebral artery territory were measured. The pre‐ and post‐CEA CTP data were used as the assessment standard for CBF change. Carotid lipid‐rich necrotic core (LRNC), intraplaque hemorrhage, calcification, fibrous cap rupture, maximum wall thickness, normalized wall index (NWI), and stenosis were determined.Statistical TestsPearson or Spearman correlation, Mann–Whitney U‐test, and linear regression.ResultsPatients with LRNC had higher rCBFpre‐CEA than those without (1.0 ± 0.1 vs. 0.9 ± 0.1, P < 0.05). NWI was weakly correlated with rCBFpre‐CEA (r = −0.213, P < 0.05) and DRCBF (r = 0.185, P < 0.05) and marginally correlated with rCBFpost‐CEA (r = 0.166, P = 0.057). LRNC was weakly correlated with rCBFpre‐CEA (r = 0.179, P < 0.05). NWI was associated with rCBFpre‐CEA (β = −0.035; 95% confidence interval [CI] [−0.064, −0.006]; P < 0.05), rCBFpost‐CEA (β = 0.042; 95% CI [0.002, 0.081]; P < 0.05) and DRCBF (β = 0.105; 95% CI [0.026, 0.185]; P < 0.05). After adjusting for confounding factors, associations of NWI with rCBFpost‐CEA (β = 0.059; 95% CI [0.016, 0.103]; P < 0.05) and DRCBF (β = 0.110; 95% CI [0.021, 0.199]; P < 0.05) remained statistically significant, while the association between NWI and rCBFpre‐CEA was no longer significant (β = −0.026; 95% CI [−0.058, 0.006]; P = 0.112).The associations of LRNC with rCBFpre‐CEA (β = 0.057; 95% CI [−0.0006, 0.114]; P = 0.052) and DRCBF (β = −0.157; 95% CI [−0.314, 0.001]; P = 0.051) were close to statistical significance. After adjusting for confounding factors, these associations were statistically significant (of LRNC vs. rCBFpre‐CEA: β = 0.060; 95% CI [0.003, 0.118]; P < 0.05; LRNC vs. DRCBF: β = −0.205; 95% CI [−0.375, −0.036]; P < 0.05).Data ConclusionCarotid plaque burden and components, particularly LRNC, might be effective indicators for CBF change following CEA.Level of Evidence 1Technical Efficacy Stage 5

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Size of carotid artery intraplaque hemorrhage and acute ischemic stroke: a cardiovascular magnetic resonance Chinese atherosclerosis risk evaluation study

Cited by 37 publications

References 27 publications

Carotid Intraplaque-Hemorrhage Volume and Its Association with Cerebrovascular Events

Carotid Intraplaque-Hemorrhage Volume and Its Association with Cerebrovascular Events

Magnetic resonance imaging of carotid plaques: current status and clinical perspectives

Associations Between Carotid Plaque Characteristics and Improvement of Cerebral Blood Perfusion in Patients With Moderate to Severe Carotid Stenosis Undergoing Carotid Endarterectomy

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