Martine T B Truijman1, Alexandra A J de Rotte1, Rune Aaslid1, Anouk C van Dijk1, Jeire Steinbuch1, Madieke I Liem1, Floris H B M Schreuder1, Anton F W van der Steen1, Mat J A P Daemen1, Robert J van Oostenbrugge1, Joachim E Wildberger1, Paul J Nederkoorn1, Jeroen Hendrikse1, Aad van der Lugt1, Marianne Eline Kooi1, Werner H Mess2. 1. From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands. 2. From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands. werner.mess@mumc.nl.
Abstract
BACKGROUND AND PURPOSE: In patients with mild to moderate symptomatic carotid artery stenosis, intraplaque hemorrhage (IPH) and a thin/ruptured fibrous cap (FC) as evaluated with MRI, and the presence of microembolic signals (MESs) as detected with transcranial Doppler, are associated with an increased risk of a (recurrent) stroke. The objective of the present study is to determine whether the prevalence of MES differs in patients with and without IPH and thin/ruptured FC, and patients with only a thin/ruptured FC without IPH. METHODS: In this multicenter, diagnostic cohort study, patients with recent transient ischemic attack or minor stroke in the carotid territory and an ipsilateral mild to moderate carotid artery plaque were included. IPH and FC status were dichotomously scored. Analysis of transcranial Doppler data was done blinded for the MRI results. Differences between groups were analyzed with Fisher exact test. RESULTS: A total of 113 patients were included. Transcranial Doppler measurements were feasible in 105 patients (average recording time, 219 minutes). A total of 26 MESs were detected in 8 of 105 patients. In 44 of 105 plaques IPH was present. In 92 of 105 plaques FC status was assessable, 36 of these had a thin/ruptured FC. No significant difference in the prevalence of MES between patients with and without IPH (P=0.46) or with thick versus thin/ruptured FC (P=0.48) was found. CONCLUSIONS: In patients with a symptomatic mild to moderate carotid artery stenosis, IPH and FC status are not associated with MES. This suggests that MRI and transcranial Doppler provide different information on plaque vulnerability. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01709045.
BACKGROUND AND PURPOSE: In patients with mild to moderate symptomatic carotid artery stenosis, intraplaque hemorrhage (IPH) and a thin/ruptured fibrous cap (FC) as evaluated with MRI, and the presence of microembolic signals (MESs) as detected with transcranial Doppler, are associated with an increased risk of a (recurrent) stroke. The objective of the present study is to determine whether the prevalence of MES differs in patients with and without IPH and thin/ruptured FC, and patients with only a thin/ruptured FC without IPH. METHODS: In this multicenter, diagnostic cohort study, patients with recent transient ischemic attack or minor stroke in the carotid territory and an ipsilateral mild to moderate carotid artery plaque were included. IPH and FC status were dichotomously scored. Analysis of transcranial Doppler data was done blinded for the MRI results. Differences between groups were analyzed with Fisher exact test. RESULTS: A total of 113 patients were included. Transcranial Doppler measurements were feasible in 105 patients (average recording time, 219 minutes). A total of 26 MESs were detected in 8 of 105 patients. In 44 of 105 plaques IPH was present. In 92 of 105 plaques FC status was assessable, 36 of these had a thin/ruptured FC. No significant difference in the prevalence of MES between patients with and without IPH (P=0.46) or with thick versus thin/ruptured FC (P=0.48) was found. CONCLUSIONS: In patients with a symptomatic mild to moderate carotid artery stenosis, IPH and FC status are not associated with MES. This suggests that MRI and transcranial Doppler provide different information on plaque vulnerability. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01709045.
Authors: Adam de Havenon; David Tirschwell; Jennifer J Majersik; Scott McNally; Gregory Stoddard; Anne Moore; Mahmud Mossa-Basha Journal: Neuroradiol J Date: 2017-06-20
Authors: Sara E Berman; Xiao Wang; Carol C Mitchell; Bornali Kundu; Daren C Jackson; Stephanie M Wilbrand; Tomy Varghese; Bruce P Hermann; Howard A Rowley; Sterling C Johnson; Robert J Dempsey Journal: Neuroimage Clin Date: 2015-08-22 Impact factor: 4.881