Carotid intraplaque haemorrhage: pathogenesis, histological classification, imaging methods and clinical value

Abstract

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.

Regulatory T Cell-Related Gene Biomarkers in the Deterioration of Atherosclerosis

“…To view the association between hub DETregRGs and atherosclerosis progression, we conducted unsupervised hierarchical clustering in the GSE28829 dataset using the “Pheatmap” package in R. Then, the expression patterns of hub DETregRGs across disease stages were validated in two independent datasets comparing stable vs. unstable plaques, including GSE120521 ( n = 8) ( 21 ) and E-TABM-190 ( n = 11) ( 22 ). We also used the GSE163154 ( n = 43) ( 23 ) dataset to further confirm the expressions of hub genes in plaques with or without intraplaque hemorrhage, a crucial feature of vulnerable atherosclerotic lesions ( 24 ). The detailed information for these datasets was demonstrated in Supplementary Table 1 .…”

Effectiveness of an individualized home-based physical activity program in surgery-free non-endarterectomized asymptomatic stroke patients: a study protocol for the PACAPh interventional randomized trial

“…To our knowledge, MRI has not yet been used in a longitudinal study aimed at assessing the evolution of carotid IPH and other instability criteria (i.e., calcifications and lipidic core volume). In a recent review [ 63 ], we proposed that MRI is likely the most effective way to diagnose in vivo carotid IPH. The results of this study should therefore provide information on the relevancy and efficiency of MRI for the monitoring of carotid plaque IPH in response to PA interventions.…”

Assessment of Carotid Plaque Stability Using Contrast-Enhanced Ultrasound and Its Correlation With the Expression of CD147 and MMP-9 in the Plaque

“…Intraplaque hemorrhage is the primary source of lipid nuclear expansion. Plaques with IPH are associated with rapid disease progression, recurrent bleeding, and other clinical events ( Camare et al, 2017 ; Mura et al, 2020 ).…”