The Importance of Carotid Artery Plaque Disruption and Hemorrhage

Fisher, Marc; Blumenfeld, Andrew; Smith, Thomas W.

doi:10.1001/archneur.1987.00520220082022

Cited by 76 publications

(28 citation statements)

References 21 publications

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“…76 First, diverse methods of definition could introduce a tremendous amount of variability in the detection of IPH. As early as the 1980s, Fisher et al 77 noted that it was dangerous to pool data, particularly when the analytical methods were different. Microscopy tended to be more sensitive for detecting IPH than macroscopy (49.2% and 33.8% here, respectively).…”

Section: Discussionmentioning

confidence: 99%

Correlation Between Carotid Intraplaque Hemorrhage and Clinical Symptoms

Gao

Chen

Bao

et al. 2007

Stroke

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Background and Purpose-We sought to investigate the association between carotid intraplaque hemorrhage (IPH) and ipsilateral symptoms of cerebral ischemia. Methods-A search was performed for clinical observational studies comparing the incidence of IPH between symptomatic and asymptomatic patients. Odds ratios (ORs) for IPH as a factor in the pathogenesis of neurologic events were calculated and combined by a meta-analysis. Interstudy heterogeneity, estimated effects, and methodologic quality of the studies were assessed. Results-Thirty-one studies were included for analysis. The reported ORs varied widely. Overall, the incidence of IPH in the symptomatic groups was significantly higher than in the asymptomatic group. However, there was an apparent trend for heterogeneity (PϽ0.00001) between studies. The random-effects summary estimator of ORs was 2.25 (95% CI, 1.57 to 3.22; PϽ0.00001). To identify potential sources of heterogeneity, subgroup analyses were performed. The pooled ORs varied greatly by stratification. Major heterogeneity was found among studies with low quality, microscopic methods of examination, significant effects, small sizes, early publication, and unequal severity of carotid stenosis in both groups. Large, recent, macroscopic, or high-quality studies, as well as studies with equal degrees of stenosis, tended to yield insignificant associations. The methods in defining and evaluating hemorrhage were very heterogeneous. Characterizations of the age, size, number, and location of hemorrhages were poorly reported and highly variable. In addition, a lack of control of confounders and selection bias were frequently identified among studies. Conclusions-Statistical inferences have suggested a plausible role in the production of cerebral ischemia; however, reliable interpretation was strongly undermined by poor methodologic quality, substantial heterogeneity, and suspicious publication bias. To preciously estimate the underlying correlation, a well-designed study with uniformity in definition and evaluation for IPH might be warranted.

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Section: Discussionmentioning

confidence: 99%

Correlation Between Carotid Intraplaque Hemorrhage and Clinical Symptoms

Gao

Chen

Bao

et al. 2007

Stroke

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“…Key Words: magnetic resonance imaging Ⅲ atherosclerosis Ⅲ carotid arteries Ⅲ stroke R upture of the fibrous cap that overlies the thrombogenic necrotic core is presently believed to play an important role in acute ischemic events, such as stroke, transient ischemic attack, myocardial infarction, and unstable angina. [1][2][3][4] Several histological studies have revealed that lesions associated with the development of ischemic symptoms typically contain a large necrotic core that is separated from the lumen by a fibrous cap that is thin or disrupted. 5,6 Because the detection of these morphological features could identify the plaques that represent a higher risk for thromboembolic complications, the development of a noninvasive method capable of assessing the state of the fibrous cap would not only improve patient stratification to medical or surgical treatment but would also provide a means of monitoring disease progression or evaluating the efficacy of therapeutic interventions.…”

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confidence: 99%

Identification of Fibrous Cap Rupture With Magnetic Resonance Imaging Is Highly Associated With Recent Transient Ischemic Attack or Stroke

et al. 2002

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Background-High-resolution MRI has been shown to be capable of distinguishing intact, thick fibrous caps from thin and ruptured caps in human carotid atherosclerosis in vivo. The aim of this study was to determine whether MRI identification of fibrous cap thinning or rupture is associated with a history of recent transient ischemic attack (TIA) or stroke. Methods and Results-Fifty-three consecutive patients (mean age, 71 years; 49 male) scheduled for carotid endarterectomy were recruited after obtaining informed consent. Twenty-eight subjects had a recent history of TIA or stroke on the side appropriate to the index carotid lesion, and 25 were asymptomatic. Preoperative carotid MRI was performed in a 1.5-T GE Signa scanner that generated T 1 -, PD-, and T 2 -weighted and three-dimensional time-of-flight images. Using previously reported MRI criteria, the fibrous cap was categorized as intact-thick, intact-thin, or ruptured for each carotid plaque by blinded review. There was a strong and statistically significant trend showing a higher percentage of symptomatic patients for ruptured caps (70%) compared with thick caps (9%) (Pϭ0.001 Mann-Whitney test for cap status versus symptoms). Compared with patients with thick fibrous caps, patients with ruptured caps were 23 times more likely to have had a recent TIA or stroke (95% CIϭ3, 210). Conclusions-MRI identification of a ruptured fibrous cap is highly associated with a recent history of TIA or stroke.Ongoing prospective studies will determine the predictive value fibrous cap characteristics, as visualized by MRI, for risk of subsequent ischemic events. Key Words: magnetic resonance imaging Ⅲ atherosclerosis Ⅲ carotid arteries Ⅲ stroke R upture of the fibrous cap that overlies the thrombogenic necrotic core is presently believed to play an important role in acute ischemic events, such as stroke, transient ischemic attack, myocardial infarction, and unstable angina. [1][2][3][4] Several histological studies have revealed that lesions associated with the development of ischemic symptoms typically contain a large necrotic core that is separated from the lumen by a fibrous cap that is thin or disrupted. 5,6 Because the detection of these morphological features could identify the plaques that represent a higher risk for thromboembolic complications, the development of a noninvasive method capable of assessing the state of the fibrous cap would not only improve patient stratification to medical or surgical treatment but would also provide a means of monitoring disease progression or evaluating the efficacy of therapeutic interventions.Of the clinical imaging modalities presently used to study atherosclerosis, MRI is unique because it is noninvasive, capable of identifying plaque tissue components with submillimeter resolution, able to provide quantitative measures of disease severity, and suitable for serial investigations. [7][8][9][10][11][12][13][14] Recent studies demonstrated that high-resolution MRI is capable of distinguishing intact, thick fibrous caps from thin o...

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“…21,22 Other investigations of endarterectomy specimens also suggested a correlation between intraplaque hemorrhage and transient ischemic attacks and stroke. 23 Other studies, however, could not confirm these observations. 24 Whether differences in plaque echogenicity can distinguish between symptomatic and asymptomatic plaques continues to be a matter of debate.…”

Section: Discussionmentioning

confidence: 86%

Characterization of Carotid Artery Plaques Using Real-time Compound B-mode Ultrasound

Kern

Szabo

Hennerici

et al. 2004

Stroke

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Background and Purpose-Real-time compound ultrasound imaging is a new technique for improving the image quality of B-mode scanning. We investigated the value of this method for the characterization of atherosclerotic plaques in the internal carotid artery. Methods-Thirty-two patients (22 men, 10 women; mean age, 75 years) with plaques of the internal carotid artery as identified by high-resolution B-mode scanning were investigated with real-time compound ultrasound imaging with the use of a 5-to 12-MHz dynamic range linear transducer on a duplex scanner. Two independent observers rated plaque morphology according to a standardized protocol. Results-The majority of plaques was classified as predominantly echogenic and as plaques of irregular surface, whereas ulcerated plaques were rarely observed. The interobserver agreement for plaque surface characterization was good for both compound ultrasound (ϭ0.72) and conventional B-mode (ϭ0.65). For the determination of plaque echogenicity, the reproducibility of compound ultrasound ( w ϭ0.83) was even higher than that of conventional B-mode ultrasound ( w ϭ0.74). According to a semiquantitative analysis, real-time compound ultrasound was rated superior in the categories plaque texture resolution, plaque surface definition, and vessel wall demarcation. Furthermore, there was a significant reduction of acoustic shadowing and reverberations. Conclusions-Real-time

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The Importance of Carotid Artery Plaque Disruption and Hemorrhage

Cited by 76 publications

References 21 publications

Correlation Between Carotid Intraplaque Hemorrhage and Clinical Symptoms

Correlation Between Carotid Intraplaque Hemorrhage and Clinical Symptoms

Identification of Fibrous Cap Rupture With Magnetic Resonance Imaging Is Highly Associated With Recent Transient Ischemic Attack or Stroke

Characterization of Carotid Artery Plaques Using Real-time Compound B-mode Ultrasound

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