No abstract

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Vulnerable carotid atherosclerotic plaques are characterised by several risk factors, such as inflammation, neovascularization and intraplaque haemorrhage (IPH). Vulnerable plaques can lead to ischemic events such as stroke. Many studies reported a relationship between IPH, plaque rupture, and ischemic stroke. Histology is the gold standard to evaluate IPH, but it required carotid endarterectomy (CEA) surgery to collect the tissue sample. In this context, several imaging methods can be used as a non-invasive way to evaluate plaque vulnerability and detect IPH. Most imaging studies showed that IPH is associated with plaque vulnerability and stroke, with magnetic resonance imaging (MRI) being the most sensitive and specific to detect IPH as a predictor of ischemic events. These conclusions are however still debated because of the limited number of patients included in these studies; further studies are required to better assess risks associated with different IPH stages. Moreover, IPH is implicated in plaque vulnerability with other risk factors which need to be considered to predict ischemic risk. In addition, MRI sequences standardization is required to compare results from different studies and agree on biomarkers that need to be considered to predict plaque rupture. In these circumstances, IPH detection by MRI could be an efficient clinical method to predict stroke. The goal of this review article is to first describe the pathophysiological process responsible for IPH, its histological detection in carotid plaques and its correlation with plaque rupture. The second part will discuss the benefits and limitations of imaging the carotid plaque, and finally the clinical interest of imaging IPH to predict plaque rupture, focusing on MRI-IPH.

Aim: Carotid artery disease (CAD) is an atherosclerotic inflammatory disease that affects the arterial wall, specifically at points of bifurcation where blood flow is disturbed. Abnormal blood rheology could participate in the pathophysiology of ischemic cardiovascular disease. Physical activity (PA) is known to improve blood rheology in several chronic disorders. This study aims to (i) compare the hemorheological profile of CAD patients and controls and (ii) investigate the associations between daily PA and hemorheological parameters in CAD patients.Methods: Blood viscosity, red blood cell (RBC) aggregation and RBC deformability were assessed in 80 patients (15 symptomatic and 65 asymptomatic) and 14 age-matched controls. Patients' PA levels were evaluated using questionnaires.Results: Symptomatic patients showed increased blood viscosity and RBC aggregation compared to healthy controls. RBC aggregation was significantly lower in the most physically active patients compared to the least physically active ones. Blood viscosity and RBC deformability did not vary according to physical activity level.Conclusions: Our results showed greater hemorheological abnormalities (blood hyper-viscosity and hyper-aggregation of red blood cells) in the most severe CAD patients, which could exacerbate the risk of stroke in patients with stenosis. As the most physically active patients had lower RBC aggregation than those who were less physically active, it is possible that regular PA may limit hemorheological alterations in CAD patients.