Key result
The proximal region of carotid plaques had significantly larger areas of intraplaque hemorrhage (14.7% vs 5.4% at 4 mm) and more thin/ruptured fibrous caps than the distal region.
Why the study?
Mechanisms contributing to intraplaque hemorrhage are not completely understood, and the distribution of intraplaque hemorrhage and thin/ruptured fibrous cap in mild-to-moderate carotid stenosis remained to be studied noninvasively.
Are intraplaque hemorrhage and thin/ruptured fibrous caps more prevalent in the proximal region compared to the distal region of carotid plaques in patients with mild-to-moderate carotid stenosis?
Observational (n=88)
Yes
Are intraplaque hemorrhage and thin/ruptured fibrous caps more prevalent in the proximal region compared to the distal region of carotid plaques in patients with mild-to-moderate carotid stenosis?
Absolute Event Rate: 14.7% vs 5.4%
p-value: p=<0.001
In patients with mild-to-moderate carotid stenosis, intraplaque hemorrhage and thin/ruptured fibrous caps are significantly more prevalent in the proximal region of the plaque, suggesting biomechanical factors play a role in plaque vulnerability.
Proximal plaque vulnerability should not yet change management in mild stenosis; hypothesis-generating for biomechanical plaque assessment.
BACKGROUND AND PURPOSE: Intraplaque hemorrhage contributes to lipid core enlargement and plaque progression, leading to plaque destabilization and stroke. The mechanisms that contribute to the development of intraplaque hemorrhage are not completely understood. A higher incidence of intraplaque hemorrhage and thin/ruptured fibrous cap (upstream of the maximum stenosis in patients with severe [≥70%] carotid stenosis) has been reported. We aimed to noninvasively study the distribution of intraplaque hemorrhage and a thin/ruptured fibrous cap in patients with mild-to-moderate carotid stenosis. MATERIALS AND METHODS: Eighty-eight symptomatic patients with stroke (<70% carotid stenosis included in the Plaque at Risk study) demonstrated intraplaque hemorrhage on MR imaging in the carotid artery plaque ipsilateral to the side of TIA/stroke. The intraplaque hemorrhage area percentage was calculated. A thin/ruptured fibrous cap was scored by comparing pre- and postcontrast black-blood TSE images. Differences in mean intraplaque hemorrhage percentages between the proximal and distal regions were compared using a paired-samples t test. The McNemar test was used to reveal differences in proportions of a thin/ruptured fibrous cap. RESULTS: We found significantly larger areas of intraplaque hemorrhage in the proximal part of the plaque at 2, 4, and 6 mm from the maximal luminal narrowing, respectively: 14.4% versus 9.6% (P = .04), 14.7% versus 5.4% (P < .001), and 11.1% versus 2.2% (P = .001). Additionally, we found an increased proximal prevalence of a thin/ruptured fibrous cap on MR imaging at 2, 4, 6, and 8 mm from the MR imaging section with the maximal luminal narrowing, respectively: 33.7% versus 18.1%, P = .007; 36.1% versus 7.2%, P < .001; 33.7% versus 2.4%, P = .001; and 30.1% versus 3.6%, P = .022. CONCLUSIONS: We demonstrated that intraplaque hemorrhage and a thin/ruptured fibrous cap are more prevalent on the proximal side of the plaque compared with the distal side in patients with mild-to-moderate carotid stenosis.
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A 2022 study conducted an observational in Mild-to-moderate carotid stenosis with intraplaque hemorrhage (n=88). Proximal region of carotid plaque vs. Distal region of carotid plaque was evaluated on Mean intraplaque hemorrhage (IPH) area percentage at 4 mm from maximal luminal narrowing (p=<0.001). The proximal region of carotid plaques had significantly larger areas of intraplaque hemorrhage (14.7% vs 5.4% at 4 mm) and more thin/ruptured fibrous caps than the distal region.
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