Carotid Intraplaque Hemorrhage and Stenosis: At What Stage of Plaque Progression Does Intraplaque Hemorrhage Occur, and When is It Most Likely to Be Associated with Symptoms? - PubMed (original) (raw)

. 2021 Jul;42(7):1285-1290.

doi: 10.3174/ajnr.A7133. Epub 2021 Apr 22.

Affiliations

Carotid Intraplaque Hemorrhage and Stenosis: At What Stage of Plaque Progression Does Intraplaque Hemorrhage Occur, and When is It Most Likely to Be Associated with Symptoms?

A S Larson et al. AJNR Am J Neuroradiol. 2021 Jul.

Abstract

Background and purpose: The relationship between carotid intraplaque hemorrhage and luminal stenosis severity is not well-established. We sought to determine whether intraplaque hemorrhage is related to carotid stenosis and at what degree of stenosis intraplaque hemorrhage most likely contributes to ischemic symptoms.

Materials and methods: Consecutive patients who underwent MR carotid plaque imaging with MPRAGE sequences to identify intraplaque hemorrhage were retrospectively reviewed. Degrees of stenoses were categorized as minimal (<30%), moderate (30%-69%), and severe (>70%). Arteries were categorized into 2 groups: symptomatic (ipsilateral to a cerebral ischemic event) and asymptomatic (from a patient without an ischemic event). Multiple regression analyses were used to determine independent associations between the degree of stenosis and intraplaque hemorrhage and the presence of intraplaque hemorrhage with symptoms among categories of stenosis.

Results: We included 449 patients with 449 carotid arteries: Two hundred twenty-five (50.1%) were symptomatic, and 224 (49.9%) were asymptomatic. An increasing degree of stenosis was independently associated with the presence of intraplaque hemorrhage (OR = 1.02; 95% confidence interval, 1.01-1.03). Intraplaque hemorrhage was independently associated with ischemic events in arteries with <30% stenosis (OR = 5.68; 95% CI, 1.49-21.69). No such association was observed in arteries with >30% stenosis. Of symptomatic arteries with minimal stenosis, 8.7% had intraplaque hemorrhage versus 1.7% of asymptomatic arteries (P = .02). No differences in intraplaque hemorrhage prevalence were found between symptomatic and asymptomatic groups with moderate (P = .18) and severe stenoses (P = .99).

Conclusions: The presence of intraplaque hemorrhage on high-resolution plaque imaging is likely most useful in identifying symptomatic plaques in cases of minimal stenosis.

© 2021 by American Journal of Neuroradiology.

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Patient- and artery-selection process.

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References

    1. Ooi YC, Gonzalez NR. Management of extracranial carotid artery disease. Cardiol Clin 2015;33:1–35 10.1016/j.ccl.2014.09.001 -DOI -PMC -PubMed
    1. Troyer A, Saloner D, Pan XM, et al. Assessment of Carotid Stenosis by Comparison with Endarterectomy Plaque Trial Investigators. Major carotid plaque surface irregularities correlate with neurologic symptoms. J Vasc Surg 2002;35:741–47 10.1067/mva.2002.121210 -DOI -PubMed
    1. Prabhakaran S, Rundek T, Ramas R, et al. Carotid plaque surface irregularity predicts ischemic stroke: the Northern Manhattan Study. Stroke 2006;37:2696–2701 10.1161/01.STR.0000244780.82190.a4 -DOI -PMC -PubMed
    1. Autret A, Pourcelot L, Saudeau D, et al. Stroke risk in patients with carotid stenosis. Lancet 1987;1:888–90 10.1016/S0140-6736(87)92861-3 -DOI -PubMed
    1. Barnett HJ, Taylor DW, Haynes RB, et al. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445–53 10.1056/NEJM199108153250701 -DOI -PubMed

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