Akram A. Hosseini
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.
Richard J. Simpson
Philip M.W. Bath
Shane T. MacSweeney
Dorothee P. Auer
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|
|Publisher||American Heart Association|
|Peer Reviewed||Peer Reviewed|
|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|
|Keywords||atherosclerotic plaque; carotid stenosis; cerebral infarction; endarterectomy; magnetic resonance imaging; stroke|
|Copyright Statement||Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf|
ACCEPTED MANUSCRIPT - MRI plaque hemorrhage for risk stratification in carotid artery disease with moderate risk under current medical therapy.pdf
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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