Key result
Carotid artery plaque with high expansive remodeling and high T1 signal intensity was associated with a higher rate of ischemic events compared to low values of both (74% vs 35%, p=0.01).
Why the study?
Does the combined assessment of MRI plaque signal intensity and expansive remodeling ratio predict ischemic events in patients with carotid artery stenosis?
Cohort (n=70)
Does the combined assessment of MRI plaque signal intensity and expansive remodeling ratio predict ischemic events in patients with carotid artery stenosis?
Absolute Event Rate: 74% vs 35%
p-value: p=0.01
Combined assessment of MRI plaque signal intensity and expansive remodeling ratio can help stratify the risk of ischemic events in patients with carotid artery stenosis.
May support carotid plaque imaging for ischemic risk stratification; hypothesis-generating and should not yet change practice.
OBJECTIVE: Plaque characteristics and morphology are important indicators of plaque vulnerability. MRI-detected intraplaque hemorrhage has a great effect on plaque vulnerability. Expansive remodeling, which has been considered compensatory enlargement of the arterial wall in the progression of atherosclerosis, is one of the criteria of vulnerable plaque in the coronary circulation. The purpose of this study was risk stratification of carotid artery plaque through the evaluation of quantitative expansive remodeling and MRI plaque signal intensity. METHODS: Both preoperative carotid artery T1-weighted axial and long-axis MR images of 70 patients who underwent carotid endarterectomy (CEA) or carotid artery stenting (CAS) were studied. The expansive remodeling ratio (ERR) was calculated from the ratio of the linear diameter of the artery at the thickest segment of the plaque to the diameter of the artery on the long-axis image. Relative plaque signal intensity (rSI) was also calculated from the axial image, and the patients were grouped as follows: Group A = rSI ≥ 1.40 and ERR ≥ 1.66; Group B = rSI< 1.40 and ERR ≥ 1.66; Group C = rSI ≥ 1.40 and ERR < 1.66; and Group D = rSI < 1.40 and ERR < 1.66. Ischemic events within 6 months were retrospectively evaluated in each group. RESULTS: Of the 70 patients, 17 (74%) in Group A, 6 (43%) in Group B, 7 (44%) in Group C, and 6 (35%) in Group D had ischemic events. Ischemic events were significantly more common in Group A than in Group D (p = 0.01). CONCLUSIONS: In the present series of patients with carotid artery stenosis scheduled for CEA or CAS, patients with plaque with a high degree of expansion of the vessel and T1 high signal intensity were at higher risk of ischemic events. The combined assessment of plaque characterization with MRI and morphological evaluation using ERR might be useful in risk stratification for carotid lesions, which should be validated by a prospective, randomized study of asymptomatic patients.
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Kurosaki et al. (2015) conducted a cohort in Carotid artery stenosis (n=70). High expansive remodeling ratio (ERR ≥ 1.66) and high relative plaque signal intensity (rSI ≥ 1.40) vs. Low ERR (< 1.66) and low rSI (< 1.40) was evaluated on Ischemic events within 6 months (p=0.01). Carotid artery plaque with high expansive remodeling and high T1 signal intensity was associated with a higher rate of ischemic events compared to low values of both (74% vs 35%, p=0.01).
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