Key result
In patients with contralateral carotid disease, angiographically normal carotid arteries (0% stenosis) exhibited substantial plaque burden with a mean percentage wall volume of 43.0% and a lipid-rich necrotic core present in 67.4% of arteries.
Cross-Sectional (n=72)
Blinded to clinical information
No
Multicontrast MRI reveals substantial atherosclerotic plaque burden and high-risk features in carotid arteries that appear normal on MR angiography, suggesting luminal stenosis underestimates disease severity.
Angiographic normalcy may underestimate plaque burden with contralateral disease; leaves open whether MRI refines carotid risk stratification.
BACKGROUND AND PURPOSE: Arterial remodeling may enable atherosclerotic disease without luminal stenosis. We sought to assess the prevalence and characteristics of atherosclerosis in angiographically normal carotid arteries. MATERIALS AND METHODS: Forty-six arteries with 0% stenosis by MRA were evaluated with multicontrast carotid MR imaging at 3T. For each artery, the percentage wall volume (wall volume/[lumen volume + wall volume] x 100%) and the presence versus absence of an LRNC, calcification, IPH, and fibrous cap rupture were recorded. In addition, the relative size of each plaque component (eg, percentage LRNC = LRNC volume/wall volume x 100%), when present, was calculated. RESULTS: The mean of percentage wall volume in arteries with 0% stenosis was 43.0 +/- 6.9% with a range from 31.6% to 60.1%. An LRNC was present in 67.4% (31/46) of arteries, calcification was present in 65.2% (30/46), IPH was present in 8.7% (4/46), and fibrous cap rupture was present in 4.3% (2/46). In arteries with an LRNC (n = 31), the average percentage LRNC volume was 8.8 +/- 7.3% with a range from 1.0% to 31.5%. For calcification (n = 30), the mean percentage calcification volume was 3.8 +/- 4.2% with a range of 0.1%-17.4%. The mean percentage IPH volume (n = 4) was 2.7 +/- 1.7% with a range of 0.5%-4.1%. CONCLUSIONS: These findings indicate that stenosis by MRA may underestimate the presence of carotid atherosclerosis, and they demonstrate the need for improved methods for accurately identifying carotid atherosclerotic plaque severity.
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Dong et al. (2009) conducted a cross-sectional in Carotid Atherosclerosis (n=72). Angiographically normal carotid arteries (0% stenosis) was evaluated on Percentage wall volume in arteries with 0% stenosis. In patients with contralateral carotid disease, angiographically normal carotid arteries (0% stenosis) exhibited substantial plaque burden with a mean percentage wall volume of 43.0% and a lipid-rich necrotic core present in 67.4% of arteries.
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