Association of Progression of Carotid Artery Wall Volume and Recurrent Transient Ischemic Attack or Stroke

Lu, Mingming; Peng, Peng; Cui, Yuanyuan; Qiao, Huiting; Li, Dongye; Cai, Jianming; Zhao, Xihai

doi:10.1161/strokeaha.117.019422

Cited by 50 publications

(35 citation statements)

References 31 publications

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“…These findings confirm that IPH volume is higher in plaques causing cerebrovascular events. 2,3,5,6,31,32 Of interest, there was no difference in lipid-IPH volume tissue, whereas the total lipid volume showed a statistically significant difference. This finding can be explained because in the old classification the lipid volume class included all the voxels <60 HU (and therefore also the IPH component); these results suggest that tissues with an attenuation between 26 to 59 HU, namely fatty components, are not associated with the presence of cerebrovascular events.…”

Section: Discussionmentioning

confidence: 82%

“…ABBREVIATIONS: AUC ¼ area under the curve; IPH ¼ intraplaque hemorrhage; ROC ¼ receiver operating characteristic S everal studies have demonstrated, in recent years, that the degree of stenosis should not be considered the only parameter to identify carotid plaque at risk of distal embolization and that additional plaque features can increase or reduce risk of plaque rupture and embolic events. [1][2][3][4] In particular, intraplaque hemorrhage (IPH) has been convincingly associated with a higher risk of ipsilateral cerebrovascular events. 5,6 Although MR imaging has been widely used to identify IPH, [7][8][9] recent evidence suggests that CT, 10 using a threshold of attenuation values of <25 HU in the carotid artery, can consistently identify the presence of IPH.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have recently shown that carotid artery plaque characteristics are associated with a risk of rupture and subsequent distal embolization. 2,3,5,24 In this study, we assessed the relationship between volume and percentage of IPH and other plaque components in the carotid artery detected with CT and their association with symptomatic status. We observed a significant association between the presence of ipsilateral cerebrovascular events and the absolute volume of IPH as well as plaque lipid content.…”

Section: Discussionmentioning

confidence: 99%

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Carotid Intraplaque-Hemorrhage Volume and Its Association with Cerebrovascular Events

Saba¹,

Micheletti²,

Brinjikji

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Our aim was to assess the relationship between volume and percentage of intraplaque hemorrhage measured using CT and the occurrence of cerebrovascular events at the time of CT. MATERIALS AND METHODS: One-hundred-twenty-three consecutive subjects (246 carotid arteries) with a mean age of 69 years who underwent CTA were included in this retrospective study. Plaque volume of components and subcomponents (including intraplaque hemorrhage volume) was quantified with dedicated software.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Carotid Intraplaque-Hemorrhage Volume and Its Association with Cerebrovascular Events

Saba¹,

Micheletti²,

Brinjikji

et al. 2019

AJNR Am J Neuroradiol

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“…Plaque volume seems to be a promising parameter related to the risk of recurrent TIA or stroke. In 2018 Lu et al 62 demonstrated that the annual progression of carotid plaque volume is independently associated with recurrent ischemic cerebrovascular events, and this measurement added value to the presence of IPH and FC rupture in terms of predicting future events. Atherosclerotic plaque volume progression and composition can facilitate the rupture of the plaques.…”

Section: Resultsmentioning

confidence: 99%

CT and MR Imaging of Carotid Wall and Plaque

Saba

Mannelli

Balestrieri

et al. 2019

J Neurosonol Neuroimag

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Imaging of the carotid artery wall is the focus of several ongoing research studies that are investigating the optimal approach to identify so-called "vulnerable plaques". Even when standard arterial luminal imaging fails to indicate a stenosis in stroke patients, a non-stenotic plaque may be responsible for the stroke. Indeed, over the past decade there has been a paradigm shift in the diagnosis and risk stratification of patients with carotid artery disease, whereby nowadays more emphasis is put on plaque characterization, mainly by using computed tomography (CT) and magnetic resonance (MR), in addition to the usual assessment of stenosis and surface irregularities. In this review, we will discuss current state-of-the-art CT and MR techniques to characterize vulnerable plaques and summarize current developments in imaging-based assessment of carotid plaques, in order to identify ideal candidates for revascularization and to monitor the effects of medical therapy. JNN 116 http://www.j-nn.org J Neurosonol Neuroimag 2019;11(2):115-125 Luca Saba, et al. Imaging of Carotid Plaque ification and therapy selection in patients with both high-and low-degree carotid artery stenosis.and size of the lipid-rich-necrotic-core (LRNC), and active plaque inflammation. In the following sections the features linked to plaque vulnerability are presented. FIG. 4. Male patient with right hand weakness with ulceration in the (A) left internal carotid artery internal carotid artery visibile in the sagittal, (B) axial and (C) Coronal planes (white arrows).

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“…In contrast, high-resolution black-blood (BB) cardiovascular magnetic resonance (CMR) imaging can noninvasively visualize and quantify the vessel lumen and wall at a relatively low cost and without radiation exposure [12][13][14][15][16]. Hence, many groups have incorporated BB CMR in order to facilitate the diagnosis of carotid artery disease [17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Assessment of carotid atherosclerotic disease using three-dimensional cardiovascular magnetic resonance vessel wall imaging: comparison with digital subtraction angiography

Wang

Liu

et al. 2020

Journal of Cardiovascular Magnetic Resonance

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Background: A three-dimensional (3D) cardiovascular magnetic resonance (CMR) vessel wall imaging (VWI) technique based on 3D T1 weighted (T1w) Sampling Perfection with Application-optimized Contrast using different flip angle Evolutions (SPACE) has recently been used as a promising CMR imaging modality for evaluating extracranial and intra-cranial vessel walls. However, this technique is yet to be validated against the current diagnostic imaging standard. We therefore aimed to evaluate the diagnostic performance of 3D CMR VWI in characterizing carotid disease using intra-arterial digital subtraction angiography (DSA) as a reference. Methods: Consecutive patients with at least unilateral > 50% carotid stenosis on ultrasound were scheduled to undergo interventional therapy were invited to participate. The following metrics were measured using 3D CMR VWI and DSA: lumen diameter of the common carotid artery (CCA) and segments C1-C7, stenosis diameter, reference diameter, lesion length, stenosis degree, and ulceration. We assessed the diagnostic sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) curve of 3D CMR VWI, and used Cohen's kappa, the intraclass correlation coefficient (ICC), and Bland-Altman analyses to assess the diagnostic agreement between 3D CMR VWI and DSA. Results: The ICC (all ICCs ≥0.96) and Bland-Altman plots indicated excellent inter-reader agreement in all individual morphologic measurements by 3D CMR VWI. Excellent agreement in all individual morphologic measurements were also found between 3D CMR VWI and DSA. In addition, 3D CMR VWI had high sensitivity (98.4, 97.4, 80.0, 100.0%), specificity (100.0, 94.5, 99.1, 98.0%), and Cohen's kappa (0.99, 0.89, 0.84, 0.96) for detecting stenosis > 50%, stenosis > 70%, ulceration, and total occlusion, respectively, using DSA as the standard. The AUC of 3D CMR VWI for predicting stenosis > 50 and > 70% were 0.998 and 0.999, respectively. Conclusions: The 3D CMR VWI technique enables accurate diagnosis and luminal feature assessment of carotid artery atherosclerosis, suggesting that this imaging modality may be useful for routine imaging workups and provide comprehensive information for both the vessel wall and lumen.

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Association of Progression of Carotid Artery Wall Volume and Recurrent Transient Ischemic Attack or Stroke

Abstract: The annual progression of carotid wall volume is independently associated with recurrent ischemic cerebrovascular events, and this measurement has added value for intraplaque hemorrhage and fibrous cap rupture in predicting future events.

Cited by 50 publications

References 31 publications

Carotid Intraplaque-Hemorrhage Volume and Its Association with Cerebrovascular Events

Carotid Intraplaque-Hemorrhage Volume and Its Association with Cerebrovascular Events

CT and MR Imaging of Carotid Wall and Plaque

Assessment of carotid atherosclerotic disease using three-dimensional cardiovascular magnetic resonance vessel wall imaging: comparison with digital subtraction angiography

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