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Intraplaque hemorrhage volume in patients with carotid atherosclerosis: How informative is it?
Sujin Kim1, Somin Jeong1, Hyo Sung Kwak2
1Student, Jeonbuk National University Medical School, South Korea.
Insights
Intraplaque hemorrhage (IPH) volume is a stroke risk factor. High-grade stenosis links to stroke, while low-grade stenosis associates with wall thickness, indicating different stroke predictors.
Area of Science:
- Vascular Neurology
- Radiology
- Cardiovascular Imaging
Background:
- Intraplaque hemorrhage (IPH) is a key feature of complex carotid atherosclerosis.
- IPH is associated with acute stroke events.
Purpose of the Study:
- To compare the predictive value of IPH volume, carotid stenosis degree, and maximal wall thickness for stroke risk.
- To identify stroke predictors in patients with carotid IPH.
Main Methods:
- Retrospective analysis of 233 patients with carotid IPH on vessel wall imaging (VWI).
- Patients categorized as symptomatic or asymptomatic based on acute focal infarction.
- Analysis of IPH volume, stenosis degree, and maximal wall thickness.
Main Results:
- Symptomatic patients had significantly higher IPH volume, stenosis degree, and wall thickness.
- Degree of stenosis correlated with stroke, especially in high-grade stenosis (>50%).
- Maximal wall thickness associated with stroke in low-grade stenosis (<50%) patients.
Conclusions:
- Carotid IPH volume is a stroke risk factor.
- Degree of stenosis is the primary stroke predictor in high-grade stenosis.
- Maximal wall thickness is the primary stroke predictor in low-grade stenosis.
Background And Purpose:
Intraplaque hemorrhage (IPH) of carotid atherosclerosis is an important feature in complex lesions preceding acute stroke events. The current study aimed to determine the role played by IPH volume compared to that of carotid stenosis or maximal wall thickness in patients with carotid IPH.
Materials And Methods:
This retrospective study included 233 patients who presented with carotid IPH on vessel wall imaging (VWI). We divided the patients into symptomatic or asymptomatic groups based on territorial acute focal infarction. The IPH volume, degree of stenosis, and maximal wall thickness on VWI were analyzed.
Results:
Of the 233 included patients with carotid IPH, 51 (21.9 %) patients showed initial clinical symptoms and positive territorial findings on diffusion-weighted imaging (DWI). Moreover, 154 (66.1 %) patients had low-grade stenosis below 50 % (n = 19: symptomatic groups). Overall, carotid IPH volume, degree of stenosis, and maximal wall thickness were all significantly higher in the symptomatic groups (p = 0.001). The degree of stenosis, in all patients and especially in those with high-grade stenosis above 50 %, was significantly correlated with territorial acute focal infarction on multivariate analysis (p < 0.01). In patients with low-grade stenosis below 50 %, maximal wall thickness was associated with territorial acute focal infarction (p = 0.48).
Conclusion:
Carotid IPH volume was a risk factor for territorial acute focal infarction. However, in patients with high-grade stenosis, the degree of stenosis was significantly linked to acute stroke. By contrast, in patients with low-grade stenosis, maximal wall thickness exhibited a significant association with acute stroke.
