Akram A Hosseini1, Richard J Simpson1, Nishath Altaf1, Philip M Bath1, Shane T MacSweeney1, Dorothee P Auer2. 1. From the Radiological Sciences, Division of Clinical Neuroscience (A.A.H., R.J.S., N.A., D.P.A.); Stroke Trials Unit, Division of Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; and Department of Vascular Surgery, Nottingham University Hospital NHS Trust, United Kingdom (R.J.S., N.A., S.T.M.). 2. From the Radiological Sciences, Division of Clinical Neuroscience (A.A.H., R.J.S., N.A., D.P.A.); Stroke Trials Unit, Division of Clinical Neuroscience (P.M.B.), University of Nottingham, United Kingdom; and Department of Vascular Surgery, Nottingham University Hospital NHS Trust, United Kingdom (R.J.S., N.A., S.T.M.). dorothee.auer@nottingham.ac.uk.
Abstract
BACKGROUND AND PURPOSE: Magnetic resonance imaging (MRI)-defined carotid plaque hemorrhage (MRIPH) can predict recurrent cerebrovascular ischemic events in severe symptomatic carotid stenosis. It is less clear whether MRIPH can improve risk stratification despite optimized medical secondary prevention in those with moderate risk. METHODS: One-hundred fifty-one symptomatic patients with 30% to 99% carotid artery stenosis (median age: 77, 60.5% men) clinically deemed to not benefit from endarterectomy were prospectively recruited to undergo MRI and clinical follow-up (mean, 22 months). The clinical carotid artery risk score could be evaluated in 88 patients. MRIPH+ve was defined as plaque intensity >150% that of adjacent muscle. Survival analyses were performed with recurrent infarction (stroke or diffusion-positive cerebral ischemia) as the main end point. RESULTS: Fifty-five participants showed MRIPH+ve; 47 had low, 36 intermediate, and 5 high carotid artery risk scores. Cox regression showed MRIPH as a strong predictor of future infarction (hazard ratio, 5.2; 95% confidence interval, 1.64-16.34; P=0.005, corrected for degree of stenosis), also in the subgroup with 50% to 69% stenosis (hazard ratio, 4.1; 95% confidence interval, 1-16.8; P=0.049). The absolute risk of future infarction was 31.7% at 3 years in MRIPH+ve versus 1.8% in patients without (P<0.002). MRIPH increased cumulative risk difference of future infarction by 47.1% at 3 years in those with intermediate carotid artery risk score (P=0.004). CONCLUSIONS: The study confirms MRIPH to be a powerful risk marker in symptomatic carotid stenosis with added value over current risk scores. For patients undergoing current secondary prevention medication with clinically uncertain benefit from recanalization, that is, those with moderate degree stenosis and intermediate carotid artery risk scores, MRIPH offers additional risk stratification.
BACKGROUND AND PURPOSE: Magnetic resonance imaging (MRI)-defined carotid plaque hemorrhage (MRIPH) can predict recurrent cerebrovascular ischemic events in severe symptomatic carotid stenosis. It is less clear whether MRIPH can improve risk stratification despite optimized medical secondary prevention in those with moderate risk. METHODS: One-hundred fifty-one symptomatic patients with 30% to 99% carotid artery stenosis (median age: 77, 60.5% men) clinically deemed to not benefit from endarterectomy were prospectively recruited to undergo MRI and clinical follow-up (mean, 22 months). The clinical carotid artery risk score could be evaluated in 88 patients. MRIPH+ve was defined as plaque intensity >150% that of adjacent muscle. Survival analyses were performed with recurrent infarction (stroke or diffusion-positive cerebral ischemia) as the main end point. RESULTS: Fifty-five participants showed MRIPH+ve; 47 had low, 36 intermediate, and 5 high carotid artery risk scores. Cox regression showed MRIPH as a strong predictor of future infarction (hazard ratio, 5.2; 95% confidence interval, 1.64-16.34; P=0.005, corrected for degree of stenosis), also in the subgroup with 50% to 69% stenosis (hazard ratio, 4.1; 95% confidence interval, 1-16.8; P=0.049). The absolute risk of future infarction was 31.7% at 3 years in MRIPH+ve versus 1.8% in patients without (P<0.002). MRIPH increased cumulative risk difference of future infarction by 47.1% at 3 years in those with intermediate carotid artery risk score (P=0.004). CONCLUSIONS: The study confirms MRIPH to be a powerful risk marker in symptomatic carotid stenosis with added value over current risk scores. For patients undergoing current secondary prevention medication with clinically uncertain benefit from recanalization, that is, those with moderate degree stenosis and intermediate carotid artery risk scores, MRIPH offers additional risk stratification.
Authors: Sonia S Anand; Jack V Tu; Dipika Desai; Phillip Awadalla; Paula Robson; Sébastien Jacquemont; Trevor Dummer; Nhu Le; Louise Parker; Paul Poirier; Koon Teo; Scott A Lear; Salim Yusuf; Jean-Claude Tardif; Francois Marcotte; David Busseuil; Jean-Pierre Després; Sandra E Black; Anish Kirpalani; Grace Parraga; Michael D Noseworthy; Alexander Dick; Jonathan Leipsic; David Kelton; Jennifer Vena; Melissa Thomas; Karleen M Schulze; Eric Larose; Alan R Moody; Eric E Smith; Matthias G Friedrich Journal: Eur Heart J Cardiovasc Imaging Date: 2020-06-01 Impact factor: 6.875
Authors: My Truong; Claes Håkansson; Makda HaileMichael; Jonas Svensson; Jimmy Lätt; Karin Markenroth Bloch; Roger Siemund; Isabel Gonçalves; Johan Wassélius Journal: BMC Med Imaging Date: 2021-08-11 Impact factor: 1.930