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Updated: May 13, 2026

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
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A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis

Published on: August 12, 2025

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

Akram A Hosseini1, Neghal Kandiyil, Shane T S Macsweeney

  • 1Division of Radiological and Imaging Sciences, University of Nottingham, Queen's Medical Campus, Nottingham, United Kingdom.

Annals of Neurology
|March 7, 2013
PubMed

Insights

Magnetic resonance imaging-defined carotid plaque hemorrhage (MRIPH) strongly predicts recurrent ischemic events and stroke in patients with symptomatic carotid stenosis. Patients without MRIPH have a very low stroke risk, questioning the need for carotid endarterectomy (CEA) in this group.

Area of Science:

  • Neurology
  • Radiology
  • Vascular Surgery

Background:

  • Carotid artery stenosis (CAS) poses a significant stroke risk.
  • Improved patient selection for carotid endarterectomy (CEA) is needed.
  • The role of plaque characteristics in predicting cerebrovascular events requires further investigation.

Purpose of the Study:

  • To evaluate the predictive value of magnetic resonance imaging-defined carotid plaque hemorrhage (MRIPH) for recurrent ipsilateral cerebral ischemic events and stroke.
  • To assess the utility of MRIPH in symptomatic patients with ≥ 50% carotid artery stenosis.

Main Methods:

  • Prospective study of 179 symptomatic patients with ≥ 50% carotid stenosis.
  • Carotid MRI to identify MRIPH (plaque signal intensity >150% of adjacent muscle).
  • Clinical follow-up, event-free survival analysis (Kaplan-Meier, Cox regression), and meta-analysis of published data.

Main Results:

  • MRIPH was present in 63.7% of patients.
  • Patients with MRIPH accounted for 92% of recurrent ipsilateral events and 96% of future strokes.
  • MRIPH was a strong predictor of recurrent ischemic events (HR=12.0) and stroke (HR=35.0).
  • Meta-analysis confirmed MRIPH association with recurrent events (OR=12.2).

Conclusions:

  • MRIPH independently and strongly predicts recurrent ischemic events and stroke in symptomatic carotid stenosis.
  • The low stroke risk in patients without MRIPH challenges the current risk-benefit assessment for CEA in this subgroup.
Abstract

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