Article

Carotid Intraplaque Hemorrhage Predicts Recurrent Symptoms in Patients With High-Grade Carotid Stenosis

Division of Rehabilitation and Ageing, University of Nottingham, Nottigham, England, United Kingdom
Stroke (Impact Factor: 6.02). 06/2007; 38(5):1633-5. DOI: 10.1161/STROKEAHA.106.473066
Source: PubMed

ABSTRACT Carotid intraplaque hemorrhage (IPH), known to be associated with plaque instability, may convey a higher stroke risk. The aim of this study was to assess whether the identification of IPH by MRI predicts recurrent clinical cerebrovascular events.
Sixty-six patients with high-grade symptomatic carotid stenosis underwent MRI of the carotid arteries and were followed until carotid endarterectomy or 30 days.
Of the 66 patients with a median follow up of 33.5 days, 44 (66.7%) were found on MRI to have ipsilateral carotid IPH. Fifteen recurrent events were associated with ipsilateral carotid IPH. Only 2 recurrent events occurred in the absence of IPH. IPH increased the risk of recurrent ischemia (hazard ratio=4.8; 95% CI=1.1 to 20.9, P<0.05).
IPH as detected by MRI predicts recurrent cerebrovascular events in patients with symptomatic high-grade carotid stenosis.

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Available from: Nishath Altaf, Aug 18, 2015
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    • "In a complementary study, six cerebrovascular events occurred in 36 asymptomatic patients (50%–70% luminal stenosis) with PH, whilst no clinical events occurred in the 39 patients without PH during a mean follow-up of 24.9 months (Singh et al., 2009). Other investigators have found a similar association between PH and subsequent ischemic events (Altaf et al., 2007; Kurosaki et al., 2011), but not always (Sun et al., 2012). Recently, Hosseini et al. (2013) reported 63.7% of hemorrhage prevalence in 179 symptomatic patients with Z50% luminal stenosis and 92% (57 out 62) patients who showed PH suffered recurrent ipsilateral events. "
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    ABSTRACT: Stroke remains the most prevalent disabling illness today, with internal carotid artery luminal stenosis due to atheroma formation responsible for the majority of ischemic cerebrovascular events. Severity of luminal stenosis continues to dictate both patient risk stratification and the likelihood of surgical intervention. But there is growing evidence to suggest that plaque morphology may help improve pre-existing risk stratification criteria. Plaque components such a fibrous tissue, lipid rich necrotic core and calcium have been well investigated but plaque hemorrhage (PH) has been somewhat overlooked. In this review we discuss the pathogenesis of PH, its role in dictating plaque vulnerability, PH imaging techniques, marterial properties of atherosclerotic tissues, in particular, those obtained based on in vivo measurements and effect of PH in modulating local biomechanics.
    Journal of Biomechanics 03/2014; 47(4):847-858. DOI:10.1016/j.jbiomech.2014.01.013 · 2.50 Impact Factor
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    • "In a complementary study, six cerebrovascular events occurred in 36 asymptomatic patients (50%–70% luminal stenosis) with PH, whilst no clinical events occurred in the 39 patients without PH during a mean follow-up of 24.9 months (Singh et al., 2009). Other investigators have found a similar association between PH and subsequent ischemic events (Altaf et al., 2007; Kurosaki et al., 2011), but not always (Sun et al., 2012). Recently, Hosseini et al. (2013) "
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    • "In a complementary study, six cerebrovascular events occurred in 36 asymptomatic patients (50%–70% luminal stenosis) with PH, whilst no clinical events occurred in the 39 patients without PH during a mean follow-up of 24.9 months (Singh et al., 2009). Other investigators have found a similar association between PH and subsequent ischemic events (Altaf et al., 2007; Kurosaki et al., 2011), but not always (Sun et al., 2012). Recently, Hosseini et al. (2013) "
    [Show abstract] [Hide abstract]
    ABSTRACT: Stroke remains the most prevalent disabling illness today, with internal carotid artery luminal stenosis due to atheroma formation responsible for the majority of ischemic cerebrovascular events. Severity of luminal stenosis continues to dictate both patient risk stratification and the likelihood of surgical intervention. But there is growing evidence to suggest that plaque morphology may help improve preexisting risk stratification criteria. Plaque components such a fibrous tissue, lipid rich necrotic core and calcium have been well investigated but plaque hemorrhage (PH) has been somewhat overlooked. In this review we discuss the pathogenesis of PH, its role in dictating plaque vulnerability, PH imaging techniques, marterial properties of atherosclerotic tissues, in particular, those obtained based on in vivo measurements and effect of PH in modulating local biomechanics.
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