Key result
Watershed infarcts were associated with a non-significant increase in the likelihood of recent intraplaque haemorrhage compared to non-watershed infarcts in patients with moderate carotid stenosis (OR 2.19).
Why the study?
Is intraplaque haemorrhage associated with watershed infarcts in patients with symptomatic moderate carotid stenosis?
Observational (n=65)
Blinded outcome assessment
Yes
Is intraplaque haemorrhage associated with watershed infarcts in patients with symptomatic moderate carotid stenosis?
Odds Ratio: 2.19 (95% CI 0.66–7.29)
Absolute Event Rate: 50% vs 31%
p-value: p=0.20
In patients with moderate symptomatic carotid stenosis, about one-fifth of brain infarcts occur in watershed areas, with a non-significant trend toward higher rates of intraplaque hemorrhage in these patients.
No significant association detected; leaves open whether intraplaque haemorrhage contributes to watershed infarcts in moderate carotid stenosis.
OBJECTIVE: Watershed infarcts (WSI) are thought to result from hemodynamic mechanism, but studies have suggested that microemboli from unstable carotid plaques may distribute preferentially in watershed areas, i.e., between two cerebral arterial territories. Intraplaque haemorrhage (IPH) is an emerging marker of plaque instability and microembolic activity. We assessed the association between WSI and IPH in patients with recently symptomatic moderate carotid stenosis. METHODS AND RESULTS: We selected 65 patients with symptomatic moderate (median NASCET degree of stenosis = 31%) carotid stenosis and brain infarct on Diffusion-Weighted Imaging (DWI) on Magnetic Resonance Imaging (MRI) from a multicentre prospective study. Fourteen (22%) had WSI (cortical, n = 8; internal, n = 4; cortical and internal, n = 2). Patients with WSI were more likely to have IPH than those without WSI although the difference was not significant (50% vs. 31%, OR = 2.19; 95% CI, 0.66-7.29; P = 0.20). After adjustment for degree of stenosis, age and gender, the results remained unchanged. CONCLUSION: About one in fifth of brain infarcts occurring in patients with moderate carotid stenosis were distributed in watershed areas. Albeit not significant, an association between IPH--more generally plaque component--and WSI, still remains possible.
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Isabel et al. (2014) conducted an observational in Symptomatic moderate carotid stenosis with brain infarct (n=65). Watershed infarcts (WSI) vs. No watershed infarcts was evaluated on Presence of recent intraplaque haemorrhage (IPH) (OR 2.19, 95% CI 0.66-7.29, p=0.20). Watershed infarcts were associated with a non-significant increase in the likelihood of recent intraplaque haemorrhage compared to non-watershed infarcts in patients with moderate carotid stenosis (OR 2.19).
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