Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: A prospective assessment with MRI-initial results

MRI is able to quantify carotid plaque size and composition with good accuracy and reproducibility and provides an opportunity to prospectively examine the relationship between plaque features and subsequent cerebrovascular events. We tested the hypothesis that the characteristics of carotid plaque,...

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Bibliographic Details
Published in:Stroke (1970) 2006-03, Vol.37 (3), p.818-823
Main Authors: TAKAYA, Norihide, CHUN YUAN, GARDEN, Gwenn A, CRAMER, Steven C, MARAVILLA, Kenneth R, HASHIMOTO, Beverly, HATSUKAMI, Thomas S, BAOCHENG CHU, SAAM, Tobias, UNDERHILL, Hunter, JIANMING CAI, NAM TRAN, POLISSAR, Nayak L, ISAAC, Carol, FERGUSON, Marina S
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Atherosclerosis (general aspects, experimental research)
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Carotid Arteries - pathology
Carotid Stenosis - diagnosis
Carotid Stenosis - pathology
Female
Humans
Ischemia - pathology
Magnetic Resonance Imaging - methods
Male
Medical sciences
Middle Aged
Multivariate Analysis
Neurology
Neurosurgery
Odds Ratio
Proportional Hazards Models
Prospective Studies
Regression Analysis
Risk Factors
Skull, brain, vascular surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Time Factors
Treatment Outcome
Ultrasonics
Vascular diseases and vascular malformations of the nervous system
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Summary:MRI is able to quantify carotid plaque size and composition with good accuracy and reproducibility and provides an opportunity to prospectively examine the relationship between plaque features and subsequent cerebrovascular events. We tested the hypothesis that the characteristics of carotid plaque, as assessed by MRI, are possible predictors of future ipsilateral cerebrovascular events. A total of 154 consecutive subjects who initially had an asymptomatic 50% to 79% carotid stenosis by ultrasound with > or =12 months of follow-up were included in this study. Multicontrast-weighted carotid MRIs were performed at baseline, and participants were followed clinically every 3 months to identify symptoms of cerebrovascular events. Over a mean follow-up period of 38.2 months, 12 carotid cerebrovascular events occurred ipsilateral to the index carotid artery. Cox regression analysis demonstrated a significant association between baseline MRI identification of the following plaque characteristics and subsequent symptoms during follow-up: presence of a thin or ruptured fibrous cap (hazard ratio, 17.0; P< or =0.001), intraplaque hemorrhage (hazard ratio, 5.2; P=0.005), larger mean intraplaque hemorrhage area (hazard ratio for 10 mm2 increase, 2.6; P=0.006), larger maximum %lipid-rich/necrotic core (hazard ratio for 10% increase, 1.6; P=0.004), and larger maximum wall thickness (hazard ratio for a 1-mm increase, 1.6; P=0.008). Among patients who initially had an asymptomatic 50% to 79% carotid stenosis, arteries with thinned or ruptured fibrous caps, intraplaque hemorrhage, larger maximum %lipid-rich/necrotic cores, and larger maximum wall thickness by MRI were associated with the occurrence of subsequent cerebrovascular events. Findings from this prospective study provide a basis for larger multicenter studies to assess the risk of plaque features for subsequent ischemic events.
ISSN:0039-2499
1524-4628
DOI:10.1161/01.STR.0000204638.91099.91