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Published on: September 25, 2019
Identification of fibrous cap rupture with magnetic resonance imaging is highly associated with recent transient
Chun Yuan1, Shao-xiong Zhang, Nayak L Polissar
1Department of Radiology, University of Washington, Seattle 98195, USA. cyuan@u.washington.edu
Background:
High-resolution MRI has been shown to be capable of distinguishing intact, thick fibrous caps from thin and ruptured caps in human carotid atherosclerosis in vivo. The aim of this study was to determine whether MRI identification of fibrous cap thinning or rupture is associated with a history of recent transient ischemic attack (TIA) or stroke.
Methods And Results:
Fifty-three consecutive patients (mean age, 71 years; 49 male) scheduled for carotid endarterectomy were recruited after obtaining informed consent. Twenty-eight subjects had a recent history of TIA or stroke on the side appropriate to the index carotid lesion, and 25 were asymptomatic. Preoperative carotid MRI was performed in a 1.5-T GE Signa scanner that generated T(1)-, PD-, and T(2)-weighted and three-dimensional time-of-flight images. Using previously reported MRI criteria, the fibrous cap was categorized as intact-thick, intact-thin, or ruptured for each carotid plaque by blinded review. There was a strong and statistically significant trend showing a higher percentage of symptomatic patients for ruptured caps (70%) compared with thick caps (9%) (P=0.001 Mann-Whitney test for cap status versus symptoms). Compared with patients with thick fibrous caps, patients with ruptured caps were 23 times more likely to have had a recent TIA or stroke (95% CI=3, 210).
Conclusions:
MRI identification of a ruptured fibrous cap is highly associated with a recent history of TIA or stroke. Ongoing prospective studies will determine the predictive value fibrous cap characteristics, as visualized by MRI, for risk of subsequent ischemic events.
Insights
Magnetic resonance imaging (MRI) can identify ruptured fibrous caps in carotid atherosclerosis. Ruptured caps are strongly linked to recent transient ischemic attack (TIA) or stroke, indicating high risk.
Area of Science:
- Vascular imaging
- Cerebrovascular disease
- Atherosclerosis imaging
Background:
- High-resolution MRI differentiates carotid plaque fibrous cap integrity (thick, thin, ruptured) in vivo.
- Carotid atherosclerosis plaque rupture is a key event in stroke pathogenesis.
Purpose of the Study:
- To determine if MRI-identified fibrous cap thinning or rupture correlates with recent transient ischemic attack (TIA) or stroke.
- To assess the association between carotid plaque morphology and recent cerebrovascular events.
Main Methods:
- Fifty-three patients undergoing carotid endarterectomy underwent preoperative carotid MRI.
- MRI scans were analyzed using established criteria to classify fibrous cap status (intact-thick, intact-thin, ruptured).
- Cap status was compared between patients with and without a history of recent TIA or stroke.
Main Results:
- A significant trend showed a higher percentage of symptomatic patients (recent TIA/stroke) with ruptured caps (70%) versus thick caps (9%).
- Patients with ruptured fibrous caps were 23 times more likely to have had a recent TIA or stroke compared to those with thick caps.
- MRI identification of fibrous cap rupture demonstrated a strong association with recent ischemic events.
Conclusions:
- MRI detection of a ruptured fibrous cap is highly associated with recent TIA or stroke.
- Carotid plaque fibrous cap characteristics visualized by MRI may predict future ischemic events.
- Further prospective studies are needed to confirm the predictive value of MRI-derived cap characteristics.
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