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Magnetic resonance imaging plaque hemorrhage for risk stratification in carotid artery disease with moderate risk under current medical therapy

Hosseini, Akram A.; Simpson, Richard J.; Altaf, Nishath; Bath, Philip M.W.; MacSweeney, Shane T.; Auer, Dorothee P.

Authors

Akram A. Hosseini

Richard J. Simpson

Nishath Altaf

Philip M.W. Bath

Shane T. MacSweeney

Dorothee P. Auer



Abstract

Background and Purpose—Magnetic resonance imaging (MRI)–defined carotid plaque hemorrhage (MRIPH) can predict recurrent cerebrovascular ischemic events in severe symptomatic carotid stenosis. It is less clear whether MRIPH can improve risk stratification despite optimized medical secondary prevention in those with moderate risk.

Methods—One-hundred fifty-one symptomatic patients with 30% to 99% carotid artery stenosis (median age: 77, 60.5% men) clinically deemed to not benefit from endarterectomy were prospectively recruited to undergo MRI and clinical follow-up (mean, 22 months). The clinical carotid artery risk score could be evaluated in 88 patients. MRIPH+ve was defined as plaque intensity >150% that of adjacent muscle. Survival analyses were performed with recurrent infarction (stroke or diffusion-positive cerebral ischemia) as the main end point.

Results—Fifty-five participants showed MRIPH+ve; 47 had low, 36 intermediate, and 5 high carotid artery risk scores. Cox regression showed MRIPH as a strong predictor of future infarction (hazard ratio, 5.2; 95% confidence interval, 1.64–16.34; P=0.005, corrected for degree of stenosis), also in the subgroup with 50% to 69% stenosis (hazard ratio, 4.1; 95% confidence interval, 1–16.8; P=0.049). The absolute risk of future infarction was 31.7% at 3 years in MRIPH+ve versus 1.8% in patients without (P

Journal Article Type Article
Publication Date Feb 14, 2017
Journal Stroke
Print ISSN 0039-2499
Electronic ISSN 1524-4628
Publisher American Heart Association
Peer Reviewed Peer Reviewed
Volume 48
Issue 3
APA6 Citation Hosseini, A. A., Simpson, R. J., Altaf, N., Bath, P. M., MacSweeney, S. T., & Auer, D. P. (2017). Magnetic resonance imaging plaque hemorrhage for risk stratification in carotid artery disease with moderate risk under current medical therapy. Stroke, 48(3), doi:10.1161/STROKEAHA.116.015504
DOI https://doi.org/10.1161/STROKEAHA.116.015504
Keywords atherosclerotic plaque; carotid stenosis; cerebral infarction; endarterectomy; magnetic resonance imaging; stroke
Publisher URL http://stroke.ahajournals.org/content/48/3/678
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf





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