Plaque Length Predicts the Incidence of Microembolic Signals in Acute Anterior Circulation Stroke

Zhao, Liqun; Zhao, Hongqin; Xu, Yicheng; Aijuan, Zhang; Zhang, Jiatang; Tian, Chenglin

doi:10.1155/2021/2005369

Cited by 9 publications

(6 citation statements)

References 30 publications

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“…In addition, we also found that plaque surface irregularity, length, and area, but not plaque thickness were associated with the presence of cerebral symptoms. Several studies have demonstrated a significant correlation between the presence of atherosclerotic plaques with an irregular surface and cerebral symptoms [ 23 , 44 , 45 ], with a reported association between carotid plaque length and area and the presence of micro-emboli and increased risk of ischemic stroke or transient ischemic attack in patients with low-grade carotid stenosis [ 25 , 46 ]. It has been reported that the growth of a carotid plaque’s length is more rapid than its corresponding thicknesses [ 46 , 47 ], suggesting that plaque area is more influenced by the length of the plaque.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have demonstrated a significant correlation between the presence of atherosclerotic plaques with an irregular surface and cerebral symptoms [23,44,45], with a reported association between carotid plaque length and area and the presence of micro-emboli and increased risk of ischemic stroke or transient ischemic attack in patients with low-grade carotid stenosis [25,46]. It has been reported that the growth of a carotid plaque's length is more rapid than its corresponding thicknesses [46,47], suggesting that plaque area is more influenced by the length of the plaque. Furthermore, our analysis revealed no significant difference in cIMT between symptomatic and asymptomatic patients.…”

Section: Plos Onementioning

confidence: 99%

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B-mode ultrasound characteristics of carotid plaques in symptomatic and asymptomatic patients with low-grade stenosis

Sultan,

Khayat,

Almutairi

et al. 2023

PLoS ONE

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Carotid plaque features assessed using B-mode ultrasound can be useful for the prediction of cerebrovascular symptoms. Therefore, the aim of this retrospective study was to determine the ability of ultrasound B-mode imaging to differentiate between carotid plaques causing less than 50% stenosis in symptomatic and asymptomatic patients. A dataset of 1,593 patients with carotid disease who underwent carotid ultrasound between 2016 and 2021 was evaluated retrospectively between January and April of 2022. A total of 107 carotid plaques from 35 symptomatic and 52 asymptomatic patients causing low-grade stenosis on B-mode images were included in the analysis. Chi-square, independent t-test and Mann-Whitney U test were used to compare the variables. There was a significant association between hypertension and the presence of cerebrovascular symptoms (p = 0.01). Predominantly hypoechoic and hyperechoic carotid plaque were significantly associated with the presence and absence of cerebrovascular symptoms, respectively (predominantly hypoechoic: p = 0.01; predominantly hyperechoic: p = 0.02). Surface irregularity was significantly associated with the presence of cerebrovascular symptoms (p = 0.02). There is was a significant difference in the carotid plaque length and area between the symptomatic and asymptomatic patients (plaque length: symptomatic median 9 mm, interquartile range [IQR] 6 mm; asymptomatic median 6 mm, IQR 4.5 mm, p = 0.01; plaque area: symptomatic median 24 mm, IQR 30 mm; asymptomatic median 14 mm, IQR 17 mm, p = 0.01); however, this difference was not significant for plaque thickness (p = 0.55), or common carotid artery intima-media thickness (p = 0.7). Our findings indicate that hypertension patients with predominantly hypoechoic carotid plaques and plaques with an irregular surface are associated with the presence of cerebrovascular symptoms. In addition, the carotid plaques in symptomatic patients were longer and larger compared to asymptomatic patients.

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Section: Discussionmentioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

B-mode ultrasound characteristics of carotid plaques in symptomatic and asymptomatic patients with low-grade stenosis

Sultan,

Khayat,

Almutairi

et al. 2023

PLoS ONE

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“…For intracranial atherosclerosis stenting, a longer stenosis length has been reported to be an independent risk factor for ISR [ 26 ]. Subsequently, carotid plaque length was studied as an independent predictor of carotid plaque leading to microembolic signals [ 9 ] and ipsilateral carotid blood flow compromise [ 27 ] and was found to be independently associated with perioperative stroke and death in patients treated with CEA and CAS [ 28 ]. In addition, carotid soft plaque thickness is associated with plaque vulnerability, with each 1-mm increase in plaque thickness associated with a 2.7-fold increase in the odds of having a stroke or TIA [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Plaque characteristics assessed by carotid computed tomography angiography (CTA), such as plaque length [ 9 ], plaque texture [ 10 ], plaque thickness [ 11 ], plaque ulceration [ 12 ], and plaque enhancement [ 13 ], are strongly associated with the development of ischemic stroke. Accurate identification of these features can help in risk stratification among patients with carotid atherosclerotic stenosis.…”

Section: Introductionmentioning

confidence: 99%

Prediction of Carotid In-Stent Restenosis by Computed Tomography Angiography Carotid Plaque-Based Radiomics

Cheng

Dong

Liu

et al. 2022

JCM

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In-stent restenosis (ISR) after carotid artery stenting (CAS) critically influences long-term CAS benefits and safety. The study was aimed at screening preoperative ISR-predictive features and developing predictive models. Thus, we retrospectively analyzed clinical and imaging data of 221 patients who underwent pre-CAS carotid computed tomography angiography (CTA) and whose digital subtraction angiography data for verifying ISR presence were available. Carotid plaque characteristics determined using CTA were used to build a traditional model. Backward elimination (likelihood ratio) was used for the radiomics model. Furthermore, a combined model was built using the traditional and radiomics features. Five-fold cross-validation was used to evaluate the accuracy of the trained classifier and stability of the selected features. Follow-up angiography showed ISR in 30 patients. Carotid plaque length and thickness were independently associated with ISR (multivariate analysis); regarding the conventional model, the area under the curve (AUC) was 0.84 and 0.82 in the training and validation cohorts, respectively. The corresponding AUC values for the radiomics-based model were 0.87 and 0.82, and those for the optimal combined model were 0.88 and 0.83. Plaque length and thickness could independently predict post-CAS ISR, and the combination of radiomics and plaque features afforded the best predictive performance.

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“… 36 Similar findings were obtained in another study in patients with symptomatic carotid artery atherosclerosis whose carotid plaque length was independently associated with microembolic signals. 37 This mechanism may help explain why increasing plaque length is related to AAE.…”

Section: Discussionmentioning

confidence: 99%

Association of Plaque Morphology With Stroke Mechanism in Patients With Symptomatic Posterior Circulation ICAD

Song

et al. 2022

Neurology

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ObjectiveAlthough the main mechanisms of stroke in patients with intracranial atherosclerotic disease (ICAD) - perforating artery occlusion (PAO) and artery-to-artery embolism (AAE) - have been identified and described, relatively little is known about the morphology of the symptomatic plaques and how they differ between these two mechanisms.MethodsWe prospectively recruited patients with acute ischemic stroke in the posterior circulation that was attributable to ICAD. 51 eligible patients were enrolled and underwent magnetic resonance imaging before being assigned to the PAO or AAE group according to probable stroke mechanism. Plaque morphological properties including plaque length, lumen area, outer wall area, plaque burden, plaque surface irregularity, vessel wall remodeling, and plaque enhancement, were assessed using high-resolution magnetic resonance imaging (HRMRI). Plaque morphological parameters of both PAO and AAE groups were compared using non-parametric tests. A binary logistic regression model was used to identify independent predictors while a receiver operating characteristic curve tested the sensitivity and specificity of the model.ResultsAmong patients who met the imaging eligibility criteria, 38 (74.5%) had PAO and 13 (25.5%) had AAE. Plaque length was shorter (6.39 [interquartile range (IQR), 5.18-7.71] mm vs 10.90 [IQR, 8.18-11.85] mm, p<0.01) in PAO patients. Plaque burden was lower in PAO group (78.00 [IQR, 71.94-86.35] % vs 86.37 [IQR, 82.24-93.04] %, p=0.04). The proportion of patients with plaque surface irregularity was higher in AAE patients than in PAO patients (19/38, 50.00% vs 12/13, 92.30%, p=0.008). Plaque length was significantly associated with the PAO mechanism (adjusted OR 0.57, 95% CI, 0.41-0.79).ConclusionIntracranial atherosclerotic plaque morphology differs between patients with PAO and those with AAE. Plaque with shorter length, lower plaque burden and regular surface is more likely to cause perforating artery occlusion.

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Plaque Length Predicts the Incidence of Microembolic Signals in Acute Anterior Circulation Stroke

Cited by 9 publications

References 30 publications

B-mode ultrasound characteristics of carotid plaques in symptomatic and asymptomatic patients with low-grade stenosis

B-mode ultrasound characteristics of carotid plaques in symptomatic and asymptomatic patients with low-grade stenosis

Prediction of Carotid In-Stent Restenosis by Computed Tomography Angiography Carotid Plaque-Based Radiomics

Association of Plaque Morphology With Stroke Mechanism in Patients With Symptomatic Posterior Circulation ICAD

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