Intraplaque Hemorrhage and the Plaque Surface in Carotid Atherosclerosis: The Plaque At RISK Study (PARISK)
van Dijk, Anouk C.; Truijman, M T B; Hussain, B; Zadi, T; Saiedie, G; de Rotte, A A J; Liem, M I; van der Steen, A F W; Daemen, M J A P; Koudstaal, P J; Nederkoorn, P J; Hendrikse, J; Kooi, M E; van der Lugt, A
(2015) American Journal of Neuroradiology, volume 36, issue 11, pp. 2127 - 33
(Article)
Abstract
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
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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 χ(2) 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.
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Keywords: Aged, Carotid Arteries, Carotid Stenosis, Diagnostic Imaging, Female, Hemorrhage, Humans, Image Interpretation, Computer-Assisted, Logistic Models, Male, Middle Aged, Plaque, Atherosclerotic, Prevalence, Prospective Studies, Risk Factors, Stroke, Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
ISSN: 0195-6108
Publisher: American Society of Neuroradiology
Note: © 2015 by American Journal of Neuroradiology.
(Peer reviewed)