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Carotid plaque hemorrhage on magnetic resonance imaging strongly predicts recurrent ischemia and stroke

Hosseini, Akram A.; Kandiyi, Neghal; MacSweeney, Shane T. S.; Altaf, Nishath; Auer, Dorothee P.


Akram A. Hosseini

Neghal Kandiyi

Shane T. S. MacSweeney

Nishath Altaf

Dorothee P. Auer


There is a recognized need to improve selection of patients with carotid artery stenosis for carotid endarterectomy (CEA). We assessed the value of magnetic resonance imaging (MRI)-defined carotid plaque hemorrhage (MRIPH) to predict recurrent ipsilateral cerebral ischemic events, and stroke in symptomatic carotid stenosis.

One hundred seventy-nine symptomatic patients with ≥50% stenosis were prospectively recruited, underwent carotid MRI, and were clinically followed up until CEA, death, or ischemic event. MRIPH was diagnosed if the plaque signal intensity was >150% that of the adjacent muscle. Event-free survival analysis was done using Kaplan–Meier plots and Cox regression models controlling for known vascular risk factors. We also undertook a meta-analysis of reported data on MRIPH and recurrent events.

One hundred fourteen patients (63.7%) showed MRIPH, suffering 92% (57 of 62) of all recurrent ipsilateral events and all but 1 (25 of 26) future strokes. Patients without MRIPH had an estimated annual absolute stroke risk of only 0.6%. Cox multivariate regression analysis proved MRIPH as a strong predictor of recurrent ischemic events (hazard ratio [HR] = 12.0, 95% confidence interval [CI] = 4.8–30.1, p 

Journal Article Type Article
Publication Date Jun 1, 2013
Journal Annals of Neurology
Print ISSN 0364-5134
Electronic ISSN 0364-5134
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 73
Issue 6
Publisher URL
Copyright Statement Copyright information regarding this work can be found at the following address:


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