The carotid bifurcation plaque: pathologic findings associated with cerebral ischemia.

Imparato, Anthony M.; Riles, Thomas S.; Gorstein, Fred

doi:10.1161/01.str.10.3.238

Cited by 241 publications

(83 citation statements)

References 20 publications

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“…2- 4 The importance of PH was suggested by Imparato et al, who reported, in 1979, that PH was responsible for 73% of focal neurological symptoms in patients with symptomatic carotid artery disease and that it played a significant role in plaque progression. 5 Similar results have been reported by Takaya et al in a longitudinal magnetic resonance imaging (MRI) study. 6 A recent systematic review (of 31 observational studies) also suggested a plausible contribution of PH to focal neurological symptom production.…”

supporting

confidence: 82%

Utility of Magnetic Resonance Imaging-Based Finite Element Analysis for the Biomechanical Stress Analysis of Hemorrhagic and Non-Hemorrhagic Carotid Plaques

Sadat

Zhang

Young

et al. 2011

Circ J

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Background: Biomechanical stress analysis has been used for plaque vulnerability assessment. The presence of plaque hemorrhage (PH) is a feature of plaque vulnerability and is associated with thromboembolic ischemic events. The purpose of the present study was to use finite element analysis (FEA) to compare the stress profiles of hemorrhagic and non-hemorrhagic profiles. Methods and Results:Forty-five consecutive patients who had suffered a cerebrovascular ischemic event with an underlying carotid artery disease underwent high-resolution magnetic resonance imaging (MRI) of their symptomatic carotid artery in a 1.5-T MRI system. Axial images were manually segmented for various plaque components and used for FEA. Maximum critical stress (M-CstressSL) for each slice was determined. Within a plaque, the maximum M-CstressSL for each slice of a plaque was selected to represent the maximum critical stress of that plaque (M-CstressPL) and used to compare hemorrhagic and non-hemorrhagic plaques. A total of 62% of plaques had hemorrhage. It was observed that plaques with hemorrhage had significantly higher stress (M-CstressPL) than plaques without PH ( Conclusions: Hemorrhagic plaques have higher biomechanical stresses than non-hemorrhagic plaques. MRIbased FEA seems to have the potential to assess plaque vulnerability. (Circ J 2011; 75: 884 - 889)

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supporting

confidence: 82%

Utility of Magnetic Resonance Imaging-Based Finite Element Analysis for the Biomechanical Stress Analysis of Hemorrhagic and Non-Hemorrhagic Carotid Plaques

Sadat

Zhang

Young

et al. 2011

Circ J

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“…While carotid IMT and stenosis have been demonstrated to have strong associations with clinically-evident stroke, 10,14,15 CT-defined infarcts, 16,17 and more recently with MRI-defined infarcts, 18,19 less information is available on relationships of atherosclerosis severity to other MRI abnormalities such as 3 and between ventricular and sulcal enlargement and severity of carotid atherosclerosis. 2 Given the strong and consistent relationships of MRI abnormalities to severity of carotid atherosclerosis, the question arises whether there are other ultrasound-definable characteristics of carotid disease that are related to MRI abnormalities.…”

Section: Carotid Disease and The Brainmentioning

confidence: 99%

“…Clinical studies of carotid atherectomy specimens suggest that ulcerated, 20 less organized, 15 and hemorrhagic 21,22 plaques are associated with symptoms. Some of these associations have been disputed, however, with other investigators failing to demonstrate more frequent symptoms associated with ulcerations 14,21 and plaque hemorrhage. 23,24 The documented ability of B-mode ultrasonographic scanning to detect plaque ulceration, 25 heterogeneity, 26,27 and hemorrhage, 28 though disputed by some, 24,29,30 has led to the demonstration that these ultrasound-defined characteristics are also associated with ipsilateral neurologic symptoms, 31 clinical events, 26 and MRI-defined infarcts.…”

Section: Carotid Disease and The Brainmentioning

confidence: 99%

Relationships of Cerebral MRI Findings to Ultrasonographic Carotid Atherosclerosis in Older Adults

Manolio

Burke

O’Leary

et al. 1999

ATVB

182

160

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Abstract-Cerebral magnetic resonance imaging (MRI) has demonstrated a high prevalence of infarct-like lesions, white matter hyperintensities, and evidence of cerebral atrophy in older adults. While these findings are generally believed to be related to ischemia and atherosclerosis, their relationship to atherosclerosis in the carotid arteries remains to be explored. Study subjects were part of the multicenter Cardiovascular Health Study, a cross-sectional study of 3502 women and men Ն65 years of age undergoing cranial MRI and carotid ultrasonography. MRI infarcts were detected in 1068 participants (29.3%) and measurable carotid plaque in 2745 (75.3%). MRI infarcts, ventricular and sulcal widening, and white matter score were strongly associated with carotid intimal-medial thickness (IMT) and stenosis degree after adjustment for age and sex (all PϽ0.01). Associations with plaque characteristics were less strong and less consistent; MRI infarcts were weakly associated only with surface irregularity, and ventricular size was weakly associated only with lesion density (both PϽ0.04). In contrast, sulcal widening was strongly related to plaque characteristics, with scores being higher in those with heterogeneous and irregular plaque (both PϽ0.009 Key Words: stroke Ⅲ cerebrovascular disorders Ⅲ carotid arteries Ⅲ atherosclerosis Ⅲ aged Ⅲ epidemiology Ⅲ risk factors C erebral magnetic resonance imaging (MRI) has demonstrated a high prevalence of infarct-like lesions, white matter hyperintensities, and evidence of cerebral atrophy in older adults. 1-3 While these findings are related to standard risk factors for cardiovascular disease and are believed to be consequences of ischemia, 4 -6 their relationship to atherosclerosis in the carotid arteries has not been widely explored.Because the carotid arteries provide the majority of the brain's blood supply, detailed information on extent, severity, and characteristics of carotid atherosclerosis can be used to explore its relationships to cerebral MRI findings. Lesion characteristics such as increased density, heterogeneity, and surface irregularity have been shown to relate to prevalent clinically defined transient ischemic attack and stroke, 6 but these associations have not been examined for cerebral MRI findings.The Cardiovascular Health Study (CHS) cohort represents a large, multicenter sample of older men and women examined by both carotid ultrasonography and cerebral MRI. Cross-sectional data from these examinations were analyzed (1) to describe prevalences of MRI-defined infarcts, infarctlike lesions, and gray and white matter changes by quintile of common and internal carotid intimal-medial thickness (IMT); degree of carotid stenosis; and characteristics of carotid plaque; (2) to determine independence of carotid atherosclerosis/MRI abnormality associations from known clinical and subclinical cardiovascular disease and cardiovascular disease risk factors; and (3) to define relationships of MRI infarcts and ipsilateral carotid artery disease. MethodsCHS participants ...

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“…The association between the presence of carotid intraplaque hemorrhage and neurologic events was first described in endarterectomy specimens. 17 In 1996, Toussaint et al showed that in T2W sequences the atheromatous core has low signal intensity relative to the fibrous cap and outer layers of the vessel wall, and that areas of the plaque containing calcified tissue exhibit very low signal intensity because of their low water proton content. 18 Plaque lipids consist primarily of unesterified cholesterol and cholesterol esters, which are associated with a short T2.…”

Section: Assessment Of Atherosclerotic Carotid Artery Plaquesmentioning

confidence: 99%

Detection of High-Risk Atherosclerotic Plaques by Magnetic Resonance Imaging

Noguchi

Yamada

Kawasaki

et al. 2013

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp he leading cause of morbidity and mortality in most developed countries is atherosclerotic cardiovascular disease, commonly caused by thrombotic occlusion of a high-risk coronary plaque, resulting in myocardial infarction or sudden cardiac death, or embolization from a high-risk carotid plaque resulting in stroke. Lesions prone to result in clinical events are termed "vulnerable" 1 or "high-risk" plaques. Despite advances in pathophysiology and pharmacologic intervention, there is a lack of adequate noninvasive imaging modalities for early detection of vulnerable or high-risk plaques. Vulnerable coronary plaques that lead to acute coronary syndrome (ACS) tend to be a thin-cap fibroatheroma, have a large lipid core, and a high degree of inflammation. 2-6 These components of vulnerable coronary plaques can be detected by intravascular ultrasound, 7,8 optic coherence tomography, 9,10 or angioscopy. 11 However, these techniques are invasive and are not practical for routine use in the management and risk assessment of high-risk patients (Table 1). 10,12 In contrast, ruptureprone carotid artery plaques are severely stenotic and predominantly fibrotic. Thus, the composition of high-risk plaques varies according to the anatomic site, with striking heterogeneity even within the same individual.The 2 most promising less invasive imaging modalities for studying atherosclerosis are multidetector row computed tomography (MDCT) and magnetic resonance imaging (MRI). Although CT has the advantage of being able to detect lipidrich cores, this modality is not effective for detecting the other components of high-risk plaques: thin-cap fibroatheroma and the presence of inflammatory cells. In contrast, high-resolution MRI has emerged as the leading noninvasive in vivo imaging modality for the characterization of atherosclerotic carotid plaques (Table 1). MRI has the potential to differentiate plaque components on the basis of biophysical and biochemical parameters. Moreover, MRI does not involve ionizing radiation and can be repeated sequentially over time.The aim of this review is to provide an overview of the recent progress in research and clinical application of MRI for studying atherosclerotic carotid and coronary plaques. MRI of AtherosclerosisAtherosclerotic plaque characterization by MRI is based on the signal intensity and morphologic appearance of the plaque on multiple contrast weightings. MRI depicts electromagnetic signals with radiofrequency from protons in a strong magnetic field. In clinical practice, MRI mainly visualizes signals from protons in free water, triglycerides, and free fatty acids. Macromolecules such as proteins and cholesterol crystals do not contribute to conventional MR signals, because they have a very short T2. Because atherosclerotic plaques contain only a small amount of triglycerides, MRI of atherosclerotic plaques mainly visualizes free water. Because calcification does not contain free water and ...

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The carotid bifurcation plaque: pathologic findings associated with cerebral ischemia.

Cited by 241 publications

References 20 publications

Utility of Magnetic Resonance Imaging-Based Finite Element Analysis for the Biomechanical Stress Analysis of Hemorrhagic and Non-Hemorrhagic Carotid Plaques

Utility of Magnetic Resonance Imaging-Based Finite Element Analysis for the Biomechanical Stress Analysis of Hemorrhagic and Non-Hemorrhagic Carotid Plaques

Relationships of Cerebral MRI Findings to Ultrasonographic Carotid Atherosclerosis in Older Adults

Detection of High-Risk Atherosclerotic Plaques by Magnetic Resonance Imaging

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