High-Intensity Signal in Carotid Plaque on Routine 3D-TOF-MRA Is a Risk Factor of Ischemic Stroke
Kiyofumi Yamada1, Masanori Kawasaki, Shinichi Yoshimura
1Department of Neurosurgery, Sato Daiichi Hospital, Oita, Japan.
Insights
High-intensity signals (HIS) in carotid plaques on 3D-TOF-MRA MIP images indicate a higher risk of prior ischemic strokes in patients with moderate carotid stenosis. This finding aids in identifying at-risk individuals for better stroke prevention strategies.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Science
Background:
- Carotid atherosclerotic disease is a significant risk factor for ischemic stroke.
- Moderate carotid stenosis, not just high-grade, can lead to ischemic events.
- Carotid intraplaque hemorrhage (IPH) is linked to cerebral ischemic events.
Purpose of the Study:
- To investigate the association between high-intensity signals (HIS) on 3D-TOF-MRA MIP images and prior ischemic strokes.
- To evaluate the role of HIS in patients with moderate carotid artery stenosis (50-69%).
Main Methods:
- Included 61 patients with moderate carotid artery stenosis.
- Defined carotid IPH as HIS on 3D-TOF-MRA MIP images.
- Analyzed the correlation between HIS and prior ischemic strokes identified by diffusion-weighted brain imaging.
Main Results:
- HIS were detected in 44% of patients.
- Prior ischemic strokes were significantly more frequent in the HIS-positive group (67% vs. 9%, p < 0.001).
- Smoking was also more prevalent in patients with prior strokes (62% vs. 25%, p = 0.005).
Conclusions:
- HIS in carotid plaques on 3D-TOF-MRA MIP images are independent predictors of prior ischemic strokes in moderate carotid stenosis.
- These findings offer a potential tool for reliable risk stratification in patients with moderate carotid artery stenosis.
Background:
Carotid atherosclerotic disease is recognized as an important risk factor for brain ischemic events. However, high-grade stenosis does not always cause ischemic strokes, whereas moderate-grade stenosis may often cause ischemic strokes. It has been reported that there is an association between carotid intraplaque hemorrhage (IPH) and new cerebral ischemic events. The purpose of this study was to elucidate the relationship between high-intensity signals (HIS) on maximum intensity projection (MIP) images from routine 3-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) and prior ischemic strokes in the patients with moderate carotid stenosis.
Materials And Methods:
Sixty-one patients with moderate carotid artery stenosis (50-69% stenosis based on North American Symptomatic Carotid Endarterectomy Trial criteria) were included. Carotid IPH was defined as the presence of HIS in carotid plaques on MIP images detected by 3D-TOF-MRA using criteria we previously reported. We analyzed the relationship between the presence of HIS in plaques and prior ischemic strokes defined as ischemic lesions on diffusion-weighted brain images.
Results:
HIS in carotid plaques were present in 27 (44%) of 61 patients. Prior ipsilateral ischemic strokes occurred more frequently in the HIS-positive group than the HIS-negative group (67 vs. 9%, p < 0.001). Furthermore, there were more smokers in the group with ischemic stroke than without it (62 vs. 25%, p = 0.005). In multivariate logistic regression analysis, HIS in carotid plaque (OR 23.4, 95% CI 4.62-118.3, p < 0.001) and smoking (OR 5.44, 95% CI 1.20-24.6, p = 0.028) were independent determinants of prior ischemic strokes after adjustment for age.
Conclusions:
HIS in carotid plaques on 3D-TOF-MRA MIP images are independent determinants of prior ischemic strokes in patients with moderate carotid artery stenosis, and they can potentially provide a reliable risk stratification of patients with moderate carotid artery stenosis.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:21Imaging Studies for Cardiovascular System IV: CMRI