Plaque Composition as a Predictor of Plaque Ulceration in Carotid Artery Atherosclerosis: The Plaque At RISK Study
Dilba, K; van Dam-Nolen, D H K; van Dijk, A C; Kassem, M; van der Steen, A F W; Koudstaal, P J; Nederkoorn, P J; Hendrikse, J; Kooi, M E; Wentzel, J J; van der Lugt, A
(2021) AJNR. American journal of neuroradiology, volume 42, issue 1, pp. 144 - 151
(Article)
Abstract
BACKGROUND AND PURPOSE: Plaque ulceration is a marker of previous plaque rupture. We studied the association between atherosclerotic plaque composition at baseline and plaque ulceration at baseline and follow-up. MATERIALS AND METHODS: We included symptomatic patients with a carotid stenosis of ,70% who underwent MDCTA and MR imaging at baseline
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(n=180). MDCTA was repeated at 2 years (n=73). We assessed the presence of ulceration using MDCTA. Baseline MR imaging was used to assess the vessel wall volume and the presence and volume of plaque components (intraplaque hemorrhage, lipid-rich necrotic core, and calcifications) and the fibrous cap status. Associations at baseline were evaluated with binary logistic regression and reported with an OR and its 95% CI. Simple statistical testing was performed in the follow-up analysis. RESULTS: At baseline, the prevalence of plaque ulceration was 27% (49/180). Increased wall volume (OR = 12.1; 95% CI, 3.5-42.0), higher relative lipid-rich necrotic core (OR= 1.7; 95% CI, 1.3-2.2), higher relative intraplaque hemorrhage volume (OR= 1.7; 95% CI, 1.3-2.2), and a thin-or-ruptured fibrous cap (OR = 3.4; 95% CI, 1.7-6.7) were associated with the presence of ulcerations at baseline. In 8% (6/73) of the patients, a new ulcer developed. Plaques with a new ulceration at follow-up had at baseline a larger wall volume (1.04 cm3 [IQR, 0.97-1.16 cm3] versus 0.86 cm3 [IQR, 0.73-1.00 cm3]; P=.029), a larger relative lipid-rich necrotic core volume (23% [IQR, 13-31%] versus 2% [IQR, 0-14%]; P=.002), and a larger relative intraplaque hemorrhage volume (14% [IQR, 8-24%] versus 0% [IQR, 0-5%]; P<.001). CONCLUSIONS: Large atherosclerotic plaques and plaques with intraplaque hemorrhage and lipid-rich necrotic cores were associated with plaque ulcerations at baseline and follow-up.
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Keywords: Aged, Carotid Artery Diseases/diagnostic imaging, Female, Humans, Lipids, Magnetic Resonance Imaging/methods, Male, Middle Aged, Necrosis/pathology, Plaque, Atherosclerotic/diagnostic imaging, Ulcer/pathology, Clinical Neurology, Radiology Nuclear Medicine and imaging, Research Support, Non-U.S. Gov't, Journal Article
ISSN: 0195-6108
Publisher: American Society of Neuroradiology
Note: Funding Information: This research was performed within the framework of the Center for Translational Molecular Medicine (www.ctmm.nl), project PARISK (Plaque At RISK; grant 01C-202) and supported by the Dutch Heart Foundation. Kristina Dilba was supported, in part, by Toegepaste en Technische Wetenschappen, project No. 10813. Funding Information: Disclosures: Kristine Dilba—RELATED: Support for Travel to Meetings for the Study or Other Purposes: Toegepaste en Technische Wetenschappen, grant No. 10813 (Stichting Technische Wetenschappen, Dutch Research Council, the Netherlands).* Mohamed Kassem—RELATED: Grant: The Dutch Research Council, Comments: Hestia Impulse. Paul J. Nederkoorn—UNRELATED: GRANTS: Dutch Heart Foundation and Netherlands Health Organisation. M. Eline Kooi—RELATED: Grant: Center for Translational Molecular Medicine PARISK*; UNRELATED: Employment: Maastricht University Medical Center; Grants/Grants Pending: Dutch Research Council, Horizon 2020 Initial Training Networks, Stichting De Weijerhorst*; Travel/Accommodations/ Meeting Expenses Unrelated to Activities Listed: American Heart Association stroke conference, Society for Magnetic Resonance Angiography meeting, Le Fil Rouge meeting, symposium European Society for Cardiology, Comments: I am regularly invited as a speaker, and part of my expenses are reimbursed.* Jolanda J. Wentzel— RELATED: Grant: Toegepaste en Technische Wetenschappen, Comments: grant for the salary of K. Dilba, grant No. STW 10813.* Anouk C. van Dijk—RELATED: Grant: Center for Translational Molecular Medicine, Dutch Heart Foundation, Comments: This research was performed within the framework of the Center for Translational Molecular Medicine (www.ctmm.nl), project PARISK (Plaque At RISK; grant 01C-202) and supported by the Dutch Heart Foundation.* *Money paid to the institution. Publisher Copyright: © 2021 American Society of Neuroradiology. All rights reserved.
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