Carotid Intraplaque-Hemorrhage Volume and Its Association with Cerebrovascular Events

Overview

Journal AJNR Am J Neuroradiol

Specialty Neurology

Date 2019 Sep 28

PMID 31558503

Citations 22

Authors

L Saba

G Micheletti

W Brinjikji

P Garofalo

R Montisci

A Balestrieri

J S Suri

J K DeMarco

G Lanzino

R Sanfilippo

Affiliations

Soon will be listed here.

Abstract

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.

Results: Forty-six arteries were excluded because no plaque was identified. In the remaining 200 carotid arteries, a statistically significant difference was found between presentation with cerebrovascular events and lipid volume ( = .002), intraplaque hemorrhage volume ( = .002), percentage of lipid ( = .002), percentage of calcium ( = .001), percentage of intraplaque hemorrhage ( = .001), percentage of lipid-intraplaque hemorrhage ( = .001), and intraplaque hemorrhage/lipid ratio ( = .001). The highest receiver operating characteristic area under the curve was obtained with the intraplaque hemorrhage volume with a value of 0.793 ( = .001), percentage of intraplaque hemorrhage with an area under the curve of 0.812 ( = .001), and the intraplaque hemorrhage/lipid ratio with an area under the curve value of 0.811 ( = .001).

Conclusions: Results of our study suggest that Hounsfield unit values <25 have a statistically significant association with the presence of cerebrovascular events and that the ratio intraplaque hemorrhage/lipid volume represents a strong parameter for the association of cerebrovascular events.

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References

Horie N, Morikawa M, Ishizaka S, Takeshita T, So G, Hayashi K . Assessment of carotid plaque stability based on the dynamic enhancement pattern in plaque components with multidetector CT angiography. Stroke. 2011; 43(2):393-8. DOI: 10.1161/STROKEAHA.111.635953. View

Touboul P, Hennerici M, Meairs S, Adams H, Amarenco P, Bornstein N . Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany,.... Cerebrovasc Dis. 2012; 34(4):290-6. PMC: 3760791. DOI: 10.1159/000343145. View

Ball S, Rogers S, Kanesalingam K, Taylor R, Katsogridakis E, McCollum C . Carotid plaque volume in patients undergoing carotid endarterectomy. Br J Surg. 2018; 105(3):262-269. PMC: 5873399. DOI: 10.1002/bjs.10670. View

Zhu G, Li Y, Ding V, Jiang B, Ball R, Rodriguez F . Semiautomated Characterization of Carotid Artery Plaque Features From Computed Tomography Angiography to Predict Atherosclerotic Cardiovascular Disease Risk Score. J Comput Assist Tomogr. 2019; 43(3):452-459. PMC: 8081566. DOI: 10.1097/RCT.0000000000000862. View

Liu Y, Wang M, Zhang B, Wang W, Xu Y, Han Y . Size of carotid artery intraplaque hemorrhage and acute ischemic stroke: a cardiovascular magnetic resonance Chinese atherosclerosis risk evaluation study. J Cardiovasc Magn Reson. 2019; 21(1):36. PMC: 6604180. DOI: 10.1186/s12968-019-0548-1. View

Hellings W, Peeters W, Moll F, Piers S, van Setten J, van der Spek P . Composition of carotid atherosclerotic plaque is associated with cardiovascular outcome: a prognostic study. Circulation. 2010; 121(17):1941-50. DOI: 10.1161/CIRCULATIONAHA.109.887497. View

Saba L, Francone M, Bassareo P, Lai L, Sanfilippo R, Montisci R . CT Attenuation Analysis of Carotid Intraplaque Hemorrhage. AJNR Am J Neuroradiol. 2017; 39(1):131-137. PMC: 7410713. DOI: 10.3174/ajnr.A5461. View

Spence J . Approaching Automated 3-Dimensional Measurement of Atherosclerotic Plaque Volume. J Am Coll Cardiol. 2017; 70(3):314-317. DOI: 10.1016/j.jacc.2017.05.036. View

Turc G, Oppenheim C, Naggara O, Eker O, Calvet D, Lacour J . Relationships between recent intraplaque hemorrhage and stroke risk factors in patients with carotid stenosis: the HIRISC study. Arterioscler Thromb Vasc Biol. 2011; 32(2):492-9. DOI: 10.1161/ATVBAHA.111.239335. View

10.

Baroncini L, Pazin Filho A, Ramos S, Martins A, Murta Jr L . Histological composition and progression of carotid plaque. Thromb J. 2007; 5:4. PMC: 1808443. DOI: 10.1186/1477-9560-5-4. View

11.

Carr S, Farb A, Pearce W, Virmani R, Yao J . Atherosclerotic plaque rupture in symptomatic carotid artery stenosis. J Vasc Surg. 1996; 23(5):755-65; discussion 765-6. DOI: 10.1016/s0741-5214(96)70237-9. View

12.

Cheng J, Chen Y, Yu Y, Chiu B . Carotid plaque segmentation from three-dimensional ultrasound images by direct three-dimensional sparse field level-set optimization. Comput Biol Med. 2018; 94:27-40. DOI: 10.1016/j.compbiomed.2018.01.002. View

13.

Alexandrov A, Bladin C, Maggisano R, Norris J . Measuring carotid stenosis. Time for a reappraisal. Stroke. 1993; 24(9):1292-6. DOI: 10.1161/01.str.24.9.1292. View

14.

Rozie S, de Weert T, de Monye C, Homburg P, Tanghe H, Dippel D . Atherosclerotic plaque volume and composition in symptomatic carotid arteries assessed with multidetector CT angiography; relationship with severity of stenosis and cardiovascular risk factors. Eur Radiol. 2009; 19(9):2294-301. PMC: 2719076. DOI: 10.1007/s00330-009-1394-6. View

15.

Saba L, Yuan C, Hatsukami T, Balu N, Qiao Y, DeMarco J . Carotid Artery Wall Imaging: Perspective and Guidelines from the ASNR Vessel Wall Imaging Study Group and Expert Consensus Recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol. 2018; 39(2):E9-E31. PMC: 7410574. DOI: 10.3174/ajnr.A5488. View

16.

Bentzon J, Otsuka F, Virmani R, Falk E . Mechanisms of plaque formation and rupture. Circ Res. 2014; 114(12):1852-66. DOI: 10.1161/CIRCRESAHA.114.302721. View

17.

Saba L, Raz E, Anzidei M, Francone M, Piga M . Differences in plaque morphology and correlation of stenosis at the carotid artery bifurcation and the carotid siphon. AJR Am J Roentgenol. 2013; 201(5):1108-14. DOI: 10.2214/AJR.12.10213. View

18.

Bezerra R, Miranda Alves M, Conforto A, Rodrigues D, Silva G . Etiological Classification of Stroke in Patients with Chagas Disease Using TOAST, Causative Classification System TOAST, and ASCOD Phenotyping. J Stroke Cerebrovasc Dis. 2017; 26(12):2864-2869. DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.007. View

19.

Saba L, Sanfilippo R, Pascalis L, Montisci R, Caddeo G, Mallarini G . Carotid artery wall thickness and ischemic symptoms: evaluation using multi-detector-row CT angiography. Eur Radiol. 2008; 18(9):1962-71. DOI: 10.1007/s00330-008-0962-5. View

20.

Sheahan M, Ma X, Paik D, Obuchowski N, Pierre S, Newman 3rd W . Atherosclerotic Plaque Tissue: Noninvasive Quantitative Assessment of Characteristics with Software-aided Measurements from Conventional CT Angiography. Radiology. 2017; 286(2):622-631. PMC: 5790306. DOI: 10.1148/radiol.2017170127. View