Differences in atheroma between Caucasian and Asian subjects with anterior stroke: A vessel wall MRI study

Background and purpose While extracranial carotid artery stenosis is more common among Caucasians and intracranial artery stenosis is more common among Asians, the differences in atherosclerotic plaque characteristics have not yet been extensively examined. We sought to investigate plaque location and characteristics within extracranial carotid and intracranial arteries in symptomatic Caucasians and Chinese using vessel wall MRI. Methods Subjects with recent anterior circulation ischaemic stroke were recruited and imaged at two sites in the USA and China using similar protocols. Both extracranial carotid and intracranial arteries were reviewed to determine plaque location and characteristics. Results The prevalence of extracranial carotid plaque in Caucasians and Chinese was 73.1% and 49.1%, respectively (p=0.055). Prevalence of intracranial plaque was 38.5% and 69.1% in Caucasians and Chinese, respectively (p=0.02). Furthermore, 42% of Caucasians and 16% of Chinese had high-risk plaque (HRP) features (intraplaque haemorrhage, luminal surface disruption) in the extracranial carotid artery (p=0.03). The prevalence of HRP features in intracranial arteries was not significantly different between the two cohorts (4% vs 11%; p=0.42). Conclusions Differences in the location and characteristics of cerebrovascular atherosclerosis were identified by vessel wall MRI in US Caucasian and Chinese subjects with recent anterior circulation ischaemic stroke. Extracranial carotid plaques with HRP features were more common in Caucasians. Intracranial plaques were more common in Chinese subjects, but no significant difference between the two cohorts in intracranial HRP prevalence was found. Larger studies using vessel wall imaging to investigate racial differences in cerebrovascular disease may inform underlying mechanisms of HRP development and may ultimately help guide appropriate therapy.

[1]  Francesca N. Delling,et al.  Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association , 2020, Circulation.

[2]  Maheshwari Patel,et al.  Study , 2019, Definitions.

[3]  Nicole L. Williams,et al.  Abstract TP116: Racial Difference in Intracranial Atherosclerotic Plaque Features by High-resolution Vessel Wall MRI , 2018 .

[4]  R. Passman,et al.  Cryptogenic Stroke: Research and Practice , 2017, Circulation research.

[5]  D J Mikulis,et al.  Intracranial Vessel Wall MRI: Principles and Expert Consensus Recommendations of the American Society of Neuroradiology , 2017, American Journal of Neuroradiology.

[6]  Yong Jiang,et al.  Prevalence, Incidence, and Mortality of Stroke in China: Results from a Nationwide Population-Based Survey of 480 687 Adults , 2017, Circulation.

[7]  P. Rothwell,et al.  Incidence, outcome, risk factors, and long-term prognosis of cryptogenic transient ischaemic attack and ischaemic stroke: a population-based study , 2015, The Lancet Neurology.

[8]  C. Yuan,et al.  Multicontrast High-Resolution Vessel Wall Magnetic Resonance Imaging and Its Value in Differentiating Intracranial Vasculopathic Processes , 2015, Stroke.

[9]  J. Mohr,et al.  A Functional Perspective on the Embryology and Anatomy of the Cerebral Blood Supply , 2015, Journal of stroke.

[10]  B. Kim,et al.  Ischemic Stroke Subtype Classification: An Asian Viewpoint , 2014, Journal of stroke.

[11]  Pina C. Sanelli,et al.  Carotid Plaque MRI and Stroke Risk: A Systematic Review and Meta-analysis , 2013, Stroke.

[12]  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.

[13]  Dorothee P Auer,et al.  Carotid Plaque Hemorrhage on Magnetic Resonance Imaging Strongly Predicts Recurrent Ischemia and Stroke , 2013, Annals of neurology.

[14]  Jianrong Xu,et al.  Simultaneous noncontrast angiography and intraPlaque hemorrhage (SNAP) imaging for carotid atherosclerotic disease evaluation , 2012, Magnetic resonance in medicine.

[15]  Byung-Chul Lee,et al.  Risk Factors and Stroke Mechanisms in Atherosclerotic Stroke: Intracranial Compared With Extracranial and Anterior Compared With Posterior Circulation Disease , 2012, Stroke.

[16]  Michael J Pencina,et al.  Carotid-wall intima-media thickness and cardiovascular events. , 2011, The New England journal of medicine.

[17]  Chun Yuan,et al.  Carotid plaque assessment using fast 3D isotropic resolution black‐blood MRI , 2011, Magnetic resonance in medicine.

[18]  K. Iihara,et al.  Assessment of necrotic core with intraplaque hemorrhage in atherosclerotic carotid artery plaque by MR imaging with 3D gradient-echo sequence in patients with high-grade stenosis. Clinical article. , 2010, Journal of neurosurgery.

[19]  C. Duyckaerts,et al.  Autopsy Prevalence of Intracranial Atherosclerosis in Patients With Fatal Stroke , 2008, Stroke.

[20]  K. Wong,et al.  Middle Cerebral Artery Atherosclerosis: Histological Comparison between Plaques Associated with and Not Associated with Infarct in a Postmortem Study , 2007, Cerebrovascular Diseases.

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

[22]  W S Kerwin,et al.  Carotid Plaque Composition Differs Between Ethno-Racial Groups: An MRI Pilot Study Comparing Mainland Chinese and American Caucasian Patients , 2005, Arteriosclerosis, thrombosis, and vascular biology.

[23]  Chun Yuan,et al.  Hemorrhage in the Atherosclerotic Carotid Plaque: A High-Resolution MRI Study , 2004, Stroke.

[24]  Chun Yuan,et al.  Classification of Human Carotid Atherosclerotic Lesions With In Vivo Multicontrast Magnetic Resonance Imaging , 2002, Circulation.

[25]  C. Yuan,et al.  Visualization of Fibrous Cap Thickness and Rupture in Human Atherosclerotic Carotid Plaque In Vivo With High-Resolution Magnetic Resonance Imaging , 2000, Circulation.

[26]  S. Lavine,et al.  Carotid stenosis in a multiethnic population. , 1998, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[27]  R. Sacco,et al.  Race-ethnicity and determinants of carotid atherosclerosis in a multiethnic population. The Northern Manhattan Stroke Study. , 1997, Stroke.

[28]  B. Litt,et al.  Race and sex differences in the distribution of cerebral atherosclerosis. , 1996, Stroke.

[29]  R. Sacco,et al.  Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. , 1995, Stroke.

[30]  D. E. Strandness,et al.  Flow separation in the carotid bulb: prognostic significance. , 1992, Neurological research.

[31]  E. Feldmann,et al.  Chinese‐white differences in the distribution of occlusive cerebrovascular disease , 1990, Neurology.

[32]  V. Hachinski,et al.  Racial differences in the anterior circulation in cerebrovascular disease. How much can be explained by risk factors? , 1990, Archives of neurology.

[33]  Daniel B Hier,et al.  Race, sex and occlusive cerebrovascular disease: a review. , 1986, Stroke.

[34]  R. Aaslid,et al.  Assessment of intracranial hemodynamics in carotid artery disease by transcranial Doppler ultrasound. , 1985, Journal of neurosurgery.

[35]  L. Mchenry,et al.  Cerebral Angiographic and Clinical Differences in Carotid System Transient Ischemic Attacks Between American Caucasian and Japanese Patients , 1984, Stroke.

[36]  R. Brust.  Patterns of Cerebrovascular Disease in Japanese and Other Population Groups in Hawaii: An Angiographical Study , 1975, Stroke.

[37]  K. Amplatz,et al.  Racial differences in cerebrovascular disease. Angiographic evaluation of Japanese and American populations. , 1967, The American journal of roentgenology, radium therapy, and nuclear medicine.

[38]  T. Sata,et al.  Acid mucopolysaccharides and lipids of Japanese arteries, with special reference to the absence of hyaluronic acid in Japanese cerebral artery. , 1966, Journal of atherosclerosis research.