Asymptomatic moderate carotid artery stenosis with intraplaque hemorrhage: Progression of degree of stenosis and new ischemic stroke. (May 2019)

• Record Type: Journal Article
• Authors: Yamada, Kiyofumi; Yoshimura, Shinichi; Shirakawa, Manabu; Uchida, Kazutaka; Nakahara, Shigehiro; Nishida, Shuji; Iwamoto, Yasuhiro; Sato, Yoshikazu; Kawasaki, Masanori
• Is Part Of: Journal of clinical neuroscience. Volume 63(2019)
• Page Start: 95
• Page End: 99
• Publication Date: 2019-05
• Subjects: Carotid artery stenosis -- MR carotid plaque imaging -- Stroke -- Intraplaque hemorrhage; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2019.01.033
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Imaging-based risk stratification strategies for carotid stenosis is important. IPH is related with accelerated plaque growth and development of ischemic strokes. IPH is visualized as high intensity signal (HIS) in the plaque on 3D-TOF MRA. HIS may be associated with new ischemic stroke and progression of stenosis. Abstract: Carotid intraplaque hemorrhage (IPH) plays a critical role in the progression of carotid atherosclerotic disease. IPH was associated with high intensity signal (HIS) in the plaque on Maximum intensity projection (MIP) images from routine three dimensional magnetic resonance imaging (3D-TOF MRA). The aim of this study was to evaluate the relationships among HIS, new ipsilateral ischemic stroke and a progression rate in carotid plaques with moderate stenosis. We included 45 carotid plaques with moderate stenosis (50%–69%) in 45 patients who could be followed more than 12 months. Carotid IPH was defined as the presence of HIS on 3DTOF MRA using the criteria previously we published. We analyzed the relation between the presence of HIS and new ischemic strokes and annual progression rate of carotid stenosis. HIS was present in 21 (47%) carotid arteries. Over a follow-up period of 24 ± 9 months, six ischemic strokes occurred in ipsilateral side. New ipsilateral ischemic stroke occurred more frequently in HIS positive group (P group: 6 of 21, 29%) than negative group (N group: 0 of 24, 0%) (p = 0.017). Annual progression rate of carotid stenosis is significantly higher in P group (+3.35%/year) than N group (−0.02%/year) (p = 0.0026). In multivariate regression analysis, HIS positive was an independent predictor for annual progression rate of carotid stenosis (p = 0.003). Evaluation of HIS in asymptomatic moderate carotid stenosis can potentially provide risk stratification of new ipsilateral ischemic strokes.