Intraplaque Hemorrhage and the Plaque Surface in Carotid Atherosclerosis: The Plaque At RISK Study (PARISK)

BACKGROUND AND PURPOSE: An important characteristic of vulnerable plaque, intraplaque hemorrhage, may predict plaque rupture. Plaque rupture can be visible on noninvasive imaging as a disruption of the plaque surface. We investigated the association between intraplaque hemorrhage and disruption of the plaque surface. MATERIALS AND METHODS: We selected the first 100 patients of the Plaque At RISK study, an ongoing prospective noninvasive plaque imaging study in patients with mild-to-moderate atherosclerotic lesions in the carotid artery. In carotid artery plaques, disruption of the plaque surface (defined as ulcerated plaques and/or fissured fibrous cap) and intraplaque hemorrhage were assessed by using MDCTA and 3T MR imaging, respectively. We used a χ2 test and multivariable logistic regression to assess the association between intraplaque hemorrhage and disrupted plaque surface. RESULTS: One hundred forty-nine carotid arteries in 78 patients could be used for the current analyses. Intraplaque hemorrhage and plaque ulcerations were more prevalent in symptomatic compared with contralateral vessels (hemorrhage, 38% versus 11%; P < .001; and ulcerations, 27% versus 7%; P = .001). Fissured fibrous cap was more prevalent in symptomatic compared with contralateral vessels (13% versus 4%; P = .06). After adjustment for age, sex, diabetes mellitus, and degree of stenosis, intraplaque hemorrhage was associated with disrupted plaque surface (OR, 3.13; 95% CI, 1.25–7.84) in all vessels. CONCLUSIONS: Intraplaque hemorrhage is associated with disruption of the plaque surface in patients with a carotid artery stenosis of <70%. Serial studies are needed to investigate whether intraplaque hemorrhage indeed increases the risk of plaque rupture and subsequent ischemic stroke during follow-up.

[1]  A F W van der Steen,et al.  Plaque at RISK (PARISK): Prospective Multicenter Study to Improve Diagnosis of High-Risk Carotid Plaques , 2014, International journal of stroke : official journal of the International Stroke Society.

[2]  J. Gillard,et al.  Plaque hemorrhage in carotid artery disease: Pathogenesis, clinical and biomechanical considerations , 2014, Journal of biomechanics.

[3]  J. DeMarco,et al.  Imaging of high-risk carotid artery plaques: current status and future directions. , 2014, Neurosurgical focus.

[4]  Fabian Bamberg,et al.  Meta-analysis and systematic review of the predictive value of carotid plaque hemorrhage on cerebrovascular events by magnetic resonance imaging. , 2013, Journal of the American College of Cardiology.

[5]  Rob J van der Geest,et al.  MRI of carotid atherosclerosis to identify TIA and stroke patients who are at risk of a recurrence , 2013, Journal of magnetic resonance imaging : JMRI.

[6]  Jasjit S Suri,et al.  Association between carotid artery plaque volume, composition, and ulceration: a retrospective assessment with MDCT. , 2012, AJR. American journal of roentgenology.

[7]  J. Michel,et al.  From intraplaque haemorrhages to plaque vulnerability: biological consequences of intraplaque haemorrhages , 2012, Journal of cardiovascular medicine.

[8]  Jean-Baptiste Michel,et al.  Intraplaque haemorrhages as the trigger of plaque vulnerability , 2011, European heart journal.

[9]  Wiro J Niessen,et al.  Association Between Carotid Artery Plaque Ulceration and Plaque Composition Evaluated With Multidetector CT Angiography , 2011, Stroke.

[10]  Peter Howard,et al.  Characterization of Carotid Plaque Hemorrhage: A CT Angiography and MR Intraplaque Hemorrhage Study , 2010, Stroke.

[11]  S. Cramer,et al.  Predictors of Surface Disruption with MR Imaging in Asymptomatic Carotid Artery Stenosis , 2010, American Journal of Neuroradiology.

[12]  C. Yuan,et al.  The added value of longitudinal black-blood cardiovascular magnetic resonance angiography in the cross sectional identification of carotid atherosclerotic ulceration , 2009, Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance.

[13]  J. Wentzel,et al.  Atherosclerotic Plaque Surface Morphology in the Carotid Bifurcation Assessed With Multidetector Computed Tomography Angiography , 2009, Stroke.

[14]  L. Saba,et al.  Fissured Fibrous Cap of Vulnerable Carotid Plaques and Symptomaticity: Are They Correlated? Preliminary Results by Using Multi-Detector-Row CT Angiography , 2009, Cerebrovascular Diseases.

[15]  E. Meijering,et al.  Intracranial Internal Carotid Artery Calcifications: Association with Vascular Risk Factors and Ischemic Cerebrovascular Disease , 2008, American Journal of Neuroradiology.

[16]  Sean Symons,et al.  In vivo 3D high-spatial-resolution MR imaging of intraplaque hemorrhage. , 2008, Radiology.

[17]  Dorothee Auer,et al.  Detection of intraplaque hemorrhage by magnetic resonance imaging in symptomatic patients with mild to moderate carotid stenosis predicts recurrent neurological events. , 2008, Journal of vascular surgery.

[18]  Luca Saba,et al.  Multidetector-row CT angiography in the study of atherosclerotic carotid arteries , 2007, Neuroradiology.

[19]  L. Saba,et al.  Efficacy and sensitivity of axial scans and different reconstruction methods in the study of the ulcerated carotid plaque using multidetector-row CT angiography: comparison with surgical results. , 2007, AJNR. American journal of neuroradiology.

[20]  Chun Yuan,et al.  Association Between Carotid Plaque Characteristics and Subsequent Ischemic Cerebrovascular Events: A Prospective Assessment With MRI—Initial Results , 2006, Stroke.

[21]  Aloke V. Finn,et al.  Atherosclerotic Plaque Progression and Vulnerability to Rupture: Angiogenesis as a Source of Intraplaque Hemorrhage , 2005, Arteriosclerosis, thrombosis, and vascular biology.

[22]  Chun Yuan,et al.  Presence of Intraplaque Hemorrhage Stimulates Progression of Carotid Atherosclerotic Plaques: A High-Resolution Magnetic Resonance Imaging Study , 2005, Circulation.

[23]  P. Rothwell,et al.  Histological Correlates of Carotid Plaque Surface Morphology on Lumen Contrast Imaging , 2004, Circulation.

[24]  Alfons G H Kessels,et al.  In vivo detection of hemorrhage in human atherosclerotic plaques with magnetic resonance imaging , 2004, Journal of magnetic resonance imaging : JMRI.

[25]  M. Eliasziw,et al.  Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery , 2004, The Lancet.

[26]  E. Boerwinkle,et al.  From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. , 2003, Circulation.

[27]  Antonio Colombo,et al.  From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part II. , 2003, Circulation.

[28]  C Yuan,et al.  Carotid atherosclerotic plaque: noninvasive MR characterization and identification of vulnerable lesions. , 2001, Radiology.

[29]  W S Kerwin,et al.  In Vivo Accuracy of Multispectral Magnetic Resonance Imaging for Identifying Lipid-Rich Necrotic Cores and Intraplaque Hemorrhage in Advanced Human Carotid Plaques , 2001, Circulation.

[30]  P. Rothwell,et al.  Interrelation between plaque surface morphology and degree of stenosis on carotid angiograms and the risk of ischemic stroke in patients with symptomatic carotid stenosis. On behalf of the European Carotid Surgery Trialists' Collaborative Group. , 2000, Stroke.

[31]  J. Slattery,et al.  Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST) , 1998, The Lancet.

[32]  D. Sackett,et al.  Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. , 1991, The New England journal of medicine.