Navneet Singh1, Alan R Moody2, Val Panzov3, David J Gladstone4. 1. Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: navneet.singh@mail.utoronto.ca. 2. Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 3. Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada. 4. Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Sunnybrook Research Institute and Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Many embolic strokes are of undetermined source (ESUS). Carotid artery intraplaque hemorrhage (IPH), an unstable component of atherosclerosis, may be an under-recognized etiology in patients with ESUS. We investigated the prevalence of carotid IPH detected noninvasively by magnetic resonance imaging (MRI). METHODS: This pilot study analyzed data from a prospective cohort of patients with a recent ESUS who underwent MRI for carotid IPH assessment. All patients had carotid artery stenosis of less than 50%. The primary outcome was the presence of carotid IPH ipsilateral to the cerebral ischemic event. RESULTS: The cohort comprised 35 consecutive patients with a recent carotid-territory ESUS who underwent carotid MRI (mean age 74.3 ± 9.6 years). We found ipsilateral and contralateral IPH in 7 of 35 patients (20.0%) and in 3 of 35 patients (8.6%), respectively (P = .005). CONCLUSIONS: In this sample of patients with ESUS, 1 in 5 had carotid IPH ipsilateral to their acute infarct, as detected by MRI of the vessel wall. Further studies are warranted to investigate carotid IPH as an etiology of ESUS.
BACKGROUND: Many embolic strokes are of undetermined source (ESUS). Carotid artery intraplaque hemorrhage (IPH), an unstable component of atherosclerosis, may be an under-recognized etiology in patients with ESUS. We investigated the prevalence of carotid IPH detected noninvasively by magnetic resonance imaging (MRI). METHODS: This pilot study analyzed data from a prospective cohort of patients with a recent ESUS who underwent MRI for carotid IPH assessment. All patients had carotid artery stenosis of less than 50%. The primary outcome was the presence of carotid IPH ipsilateral to the cerebral ischemic event. RESULTS: The cohort comprised 35 consecutive patients with a recent carotid-territory ESUS who underwent carotid MRI (mean age 74.3 ± 9.6 years). We found ipsilateral and contralateral IPH in 7 of 35 patients (20.0%) and in 3 of 35 patients (8.6%), respectively (P = .005). CONCLUSIONS: In this sample of patients with ESUS, 1 in 5 had carotid IPH ipsilateral to their acute infarct, as detected by MRI of the vessel wall. Further studies are warranted to investigate carotid IPH as an etiology of ESUS.
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