Detection of unstable carotid artery stenosis using MRI

Esposito, L.; Sievers, Marc; Sander, Dirk; Heider, P.; Wolf, Oliver T.; Greil, O.; Zimmer, Claus; Poppert, Holger

doi:10.1007/s00415-007-0634-4

Cited by 19 publications

(17 citation statements)

References 48 publications

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“…Retrospective studies have already shown a relation between MRI-detected unstable plaque lesions and recent neurological symptoms [22]. In a previous study we found MRI-defined unstable carotid plaques to be clearly overrepresented in patients with symptomatic carotid artery stenosis [23] and especially in diabetic patients [24].…”

Section: Introductionmentioning

confidence: 83%

“…Independent data safety monitoring was provided by the local clinical study center (Münchner Studienzentrum) at the Technische Universität München. Patient data were partially acquired from a pooled data set of patients undergoing MRI plaque imaging [23], [24], [26]. The methods used in the study were in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

MRI Plaque Imaging Detects Carotid Plaques with a High Risk for Future Cerebrovascular Events in Asymptomatic Patients

Esposito-Bauer

Saam²,

Ghodrati

et al. 2013

PLoS ONE

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PurposeThe aim of this study was to investigate prospectively whether MRI plaque imaging can identify patients with asymptomatic carotid artery stenosis who have an increased risk for future cerebral events. MRI plaque imaging allows categorization of carotid stenosis into different lesion types (I–VIII). Within these lesion types, lesion types IV–V and VI are regarded as rupture-prone plaques, whereas the other lesion types represent stable ones.MethodsEighty-three consecutive patients (45 male (54.2%); age 54–88 years (mean 73.2 years)) presenting with an asymptomatic carotid stenosis of 50–99% according to ECST-criteria were recruited. Patients were imaged with a 1.5-T scanner. T1-, T2-, time-of-flight-, and proton-density weighted studies were performed. The carotid plaques were classified as lesion type I–VIII. Clinical endpoints were ischemic stroke, TIA or amaurosis fugax. Survival analysis and log rank test were used to ascertain statistical significance.ResultsSix out of 83 patients (7.2%) were excluded: 4 patients had insufficient MR image quality; 1 patient was lost-to-follow-up; 1 patient died shortly after the baseline MRI plaque imaging. The following results were obtained by analyzing the remaining 77 patients. The mean time of follow-up was 41.1 months.During follow-up, n = 9 (11.7%) ipsilateral ischemic cerebrovascular events occurred. Only patients presenting with the high-risk lesion types IV–V and VI developed an ipsilateral cerebrovascular event versus none of the patients presenting with the stable lesion types III, VII, and VIII (n = 9 (11.7%) vs. n = 0 (0%) during follow-up). Event-free survival was higher among patients with the MRI-defined stable lesion types (III, VII, and VIII) than in patients with the high-risk lesion types (IV–V and VI) (log rank test P<0.0001).ConclusionsMRI plaque imaging has the potential to identify patients with asymptomatic carotid stenosis who are particularly at risk of developing future cerebral ischemia. MRI could improve selection criteria for invasive therapy in the future.

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Section: Introductionmentioning

confidence: 83%

Section: Methodsmentioning

confidence: 99%

MRI Plaque Imaging Detects Carotid Plaques with a High Risk for Future Cerebrovascular Events in Asymptomatic Patients

Esposito-Bauer

Saam²,

Ghodrati

et al. 2013

PLoS ONE

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“…Further studies combining newly developed plaque imaging techniques [14] and analyses of biochemical markers of inflammation are required to improve the understanding of the role of inflammation in the genesis of atherosclerosis. Insight into these processes may lead to novel therapeutic strategies and improved risk prevention of atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

High-sensitivity C-reactive protein at different stages of atherosclerosis: results of the INVADE study

et al. 2009

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Evidence on the role of high-sensitivity C-reactive protein (hsCRP) at different stages of atherosclerosis is limited. We therefore analyzed the relationship between hsCRP and measures of subclinical and advanced atherosclerosis in a population-based sample of the INVADE study (n = 3,092, >55 years). The parameters of interest were IMT, ABI, and the stage of atherosclerosis. Differences between participants with normal and pathological hsCRP were analyzed by t test for independent samples or Fishers' exact test. Differences of hsCRP between IMT quartiles, ABI quartiles, and different stages of atherosclerosis were analyzed by one-way ANOVA. Adjusted stepwise multiple linear regression analysis (IMT and ABI) and adjusted analysis of variance (stage of atherosclerosis) were performed, including significant baseline parameters as covariates. ANOVA showed significant differences of hsCRP among IMT quartiles, ABI quartiles, and patients with and without atherosclerosis. The adjusted analyses confirmed that the effects of IMT, ABI, and atherosclerosis on hsCRP were independent from other significant baseline parameters, but did not yield a significant difference between subclinical and advanced stages of atherosclerosis. The present analysis indicates an independent relationship between hsCRP and both IMT and ABI as measures of subclinical atherosclerosis. The comparison of subclinical and advanced stages of atherosclerosis yielded no significant difference, indicating that hsCRP is sensitive to identify vascular risk patients, but not suited to monitor progression of the disease.

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“…Allerdings gibt es zuneh− mend Versuche, instabile von stabilen asympto− matischen Stenosen zu differenzieren, um Hoch− risikopatienten zu selektieren, die von einer inva− siven Therapie der Stenose besonders profitieren. Verschiedene Untersuchungen konnten zeigen, dass es mittels hochauflösender MRT unter Ein− satz geeigneter Sequenzen und spezieller Spulen möglich ist, Kriterien für instabile Plaques zu de− finieren [62,63]. In einer aktuellen prospektiven Untersuchung bei Patienten mit mittelgradiger asymptomatischer Karotisstenose waren der MRT−Nachweis einer nur dünnen oder rupturier− ten fibrösen Kappe (Hazard Ratio, HR 17) bzw.…”

Section: Risikofaktoren Erkennen Und Behandelnunclassified