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Patients with Carotid Intraplaque Hemorrhage Have Higher Incidence of Cerebral Microbleeds
Valentina Nardi1, John C Benson2, Luca Saba3
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Aims:
Carotid intraplaque hemorrhage (IPH) is considered a marker of plaque vulnerability. Cerebral microbleeds (CMBs) are recognized on magnetic resonance imaging (MRI) in patients with cerebrovascular disease. Any connection between carotid IPH and CMBs remains scantly investigated. This study aimed to determine whether the histologic evidence of carotid IPH is related to CMBs.
Methods:
We retrospectively enrolled 101 consecutive patients undergoing carotid endarterectomy with symptomatic (ischemic stroke, TIA, and amaurosis fugax) or asymptomatic ipsilateral carotid artery disease. The presence and the extent (%) of IPH were identified on carotid plaques stained with Movat Pentachrome. CMBs were localized on T2*-weighted gradient-recalled echo or susceptibility-weighted imaging sequence on brain MRI before surgery. The degree of carotid stenosis was measured by neck CTA.
Results:
IPH was identified in 57 (56.4%) patients, and CMBs were found in 24 (23.7%) patients. CMBs were more commonly observed in patients with carotid IPH compared to those without [19 (33.3%) vs 5 (11.4%); P=0.010]. The carotid IPH extent was significantly higher in patients with CMBs than in those without [9.0 % (2.8-27.1%) vs 0.9% (0.0-13.9%); P=0.004] and was associated with the number of CMBs (P=0.004). Logistic regression analysis demonstrated an independent association between carotid IPH extent and the presence of CMBs [OR 1.051 (95% CI 1.012-1.090); P=0.009]. Additionally, patients with CMBs had a lower degree of ipsilateral carotid stenosis compared to those without [40% (35-65%) vs 70% (50-80%); P=0.049].
Conclusions:
CMBs may be potential markers of the ongoing process of carotid IPH, especially in those with nonobstructive plaques.
Insights
Carotid intraplaque hemorrhage (IPH) is linked to cerebral microbleeds (CMBs). Patients with IPH were more likely to have CMBs, suggesting CMBs may indicate active carotid plaque instability.
Area of Science:
- Neurology
- Vascular Biology
- Radiology
Background:
- Carotid intraplaque hemorrhage (IPH) signifies vulnerable atherosclerotic plaques.
- Cerebral microbleeds (CMBs) are visible on MRI and associated with cerebrovascular disease.
- The relationship between carotid IPH and CMBs is not well-established.
Purpose of the Study:
- To investigate the association between histologic evidence of carotid intraplaque hemorrhage (IPH) and the presence of cerebral microbleeds (CMBs).
Main Methods:
- Retrospective analysis of 101 patients undergoing carotid endarterectomy.
- Histologic assessment of carotid plaques for IPH presence and extent using Movat Pentachrome staining.
- Brain MRI (T2*-weighted or susceptibility-weighted imaging) to detect CMBs.
- Neck CTA for carotid stenosis measurement.
Main Results:
- IPH was found in 56.4% of patients; CMBs were present in 23.7%.
- CMBs were significantly more common in patients with carotid IPH (33.3% vs 11.4%).
- Carotid IPH extent was greater in patients with CMBs and independently associated with CMB presence (OR 1.051). Patients with CMBs had lower carotid stenosis (40% vs 70%).
Conclusions:
- Cerebral microbleeds (CMBs) may serve as indicators of active carotid intraplaque hemorrhage (IPH).
- This association is particularly relevant in cases of nonobstructive carotid plaques.
