High-Resolution MRI-Derived Carotid Plaque Feature for Long-Term Cardiovascular Risk Stratification After Carotid
Sunan Xu1, Yunhao Lei1, Lu Li1
1Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, China.
Insights
High-spatial-resolution vessel-wall MRI (HR-MRI) identified intraplaque hemorrhage (IPH) as a predictor of cardiovascular events after carotid revascularization. This imaging marker may improve risk stratification for patients undergoing these procedures.
Area of Science:
- Cardiovascular imaging and intervention
- Atherosclerosis research
- Medical diagnostics
Background:
- Carotid revascularization procedures aim to reduce stroke risk in patients with carotid artery stenosis.
- Accurate risk stratification is crucial for optimizing patient selection and post-procedural management.
- High-spatial-resolution vessel-wall MRI (HR-MRI) offers detailed insights into carotid plaque composition.
Purpose of the Study:
- To assess the prognostic capability of carotid plaque features, specifically intraplaque hemorrhage (IPH) identified via HR-MRI, for predicting long-term major adverse cardiovascular events (MACE) following carotid revascularization.
- To determine if IPH volume and location predict MACE in patients undergoing carotid endarterectomy (CEA) or carotid artery stenting (CAS).
Main Methods:
- A cohort of 296 patients undergoing carotid revascularization with preoperative HR-MRI were analyzed.
- Ipsilateral intraplaque hemorrhage (IPH) volume was quantified using HR-MRI (SNAP images).
- Cox regression, Kaplan-Meier analysis, and prediction models (C-index, calibration, DCA) were used to evaluate the association between IPH and MACE (cardiovascular death, myocardial infarction, coronary revascularization, stroke).
Main Results:
- Ipsilateral IPH volume independently predicted MACE in the overall cohort and in both CEA and CAS subgroups (HRs ranging from 1.21 to 1.49).
- Contralateral IPH was also independently associated with higher MACE risk across all groups (HRs ranging from 2.37 to 2.79).
- Patients with IPH had significantly lower event-free survival; prediction models showed good discrimination and calibration.
Conclusions:
- Ipsilateral IPH volume and the presence of contralateral IPH, as assessed by HR-MRI, are significant independent predictors of long-term cardiovascular events after carotid revascularization.
- Carotid IPH serves as a valuable imaging marker of systemic atherosclerotic vulnerability.
- These findings can enhance individualized risk stratification for patients undergoing carotid revascularization procedures.
Purpose:
To evaluate the prognostic value of carotid plaque features derived from high-spatial-resolution vessel-wall MRI (HR-MRI) for long-term major adverse cardiovascular events (MACE) after carotid revascularization.
Methods:
Consecutive patients undergoing carotid revascularization between April 2017 and April 2024 with preoperative carotid HR-MRI were included. Ipsilateral intraplaque hemorrhage (IPH) was identified as a hyperintense plaque component on SNAP images and manually segmented on each relevant slice using Vessel Explorer 2.0 software. IPH volume was calculated as the sum of the segmented IPH areas multiplied by slice thickness. MACE comprised cardiovascular death, nonfatal myocardial infarction, coronary revascularization, and stroke. Associations were assessed using Cox regression and Kaplan-Meier analysis. Prediction models were evaluated using the concordance index (C-index), calibration, and decision curve analysis (DCA).
Results:
Among 296 patients (mean age [65.04 ± 9.47] years; 244 [82.4%] men), 154 underwent carotid endarterectomy (CEA) and 142 underwent carotid artery stenting (CAS). During a median follow-up of 4.5 years, ipsilateral IPH volume was an independent predictor of MACE in the overall cohort (hazard ratio [HR], 1.49; 95% confidence interval [CI], 1.34-1.66; P < .001), as well as in the CEA subgroup (HR, 1.31; 95% CI, 1.11-1.55; P = .001) and CAS subgroup (HR, 1.21; 95% CI, 1.05-1.40; P = .007). Contralateral IPH was also independently associated with higher event risk in the overall cohort (HR, 2.37; 95% CI, 1.34-4.19; P = .003) and in both procedural subgroups (CEA: HR, 2.79; 95% CI, 1.16-6.67; P = .022; CAS: HR, 2.47; 95% CI, 1.22-5.00; P = .012). Kaplan-Meier analysis showed significantly lower event-free survival in patients with ipsilateral or contralateral IPH. Prediction models demonstrated acceptable discrimination (C-index: overall, 0.725; CEA, 0.755; CAS, 0.711), good calibration, and consistent clinical net benefit.
Conclusions:
Among HR-MRI-derived carotid plaque features, ipsilateral IPH volume and the presence of contralateral IPH were independently associated with long-term cardiovascular events after carotid revascularization. These findings support carotid IPH as an imaging marker of systemic atherosclerotic vulnerability and may improve individualized risk stratification after revascularization.
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