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Sun B, Ge X, Li X, Zhang J, Zhao Z, Liu X, Zhou Y, Xu J, Zhao H, Sun J. Elevated Hemoglobin A1c Is Associated With Leaky Plaque Neovasculature as Detected by Dynamic Contrast-Enhanced Magnetic Resonance Imaging. Arterioscler Thromb Vasc Biol 2022; 42:504-513. [PMID: 35236109 DOI: 10.1161/atvbaha.121.317190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with diabetes have accelerated atherosclerosis progression, but the underlying mechanisms are not fully understood. Dynamic contrast-enhanced magnetic resonance imaging has allowed in vivo characterization of plaque neovasculature, which plays a critical role in plaque progression. We aimed to evaluate the impact of diabetes on carotid plaque neovasculature as assessed by dynamic contrast-enhanced magnetic resonance imaging. METHODS Patients with recent ischemic stroke and ipsilateral carotid plaque underwent multicontrast magnetic resonance imaging for characterizing plaque morphology and dynamic contrast-enhanced magnetic resonance imaging for pharmacokinetic parameters of plaque neovasculature, including transfer constant (Ktrans, reflecting flow, endothelial surface area, and permeability) and fractional plasma volume (νp). RESULTS Sixty-five patients were enrolled, including 30 patients with diabetes (years since diagnosis: median 5.0 [interquartile range, [3.0-12.0]) and 35 patients without diabetes. Subjects with diabetes had a greater plaque burden and a higher prevalence of high-risk characteristics. Additionally, carotid plaques in the subjects with diabetes showed higher Ktrans than those in the subjects without diabetes (0.100±0.048 min-1 versus 0.067±0.042 min-1, P=0.005) but νp was numerically lower in the subjects with diabetes (5.2±3.7% versus 6.2±4.3%, P=0.31). The association of diabetes with high Ktrans (β=0.033, P=0.005) was independent of patient and plaque characteristics and remained largely intact after adjusting for serum lipids, glucose, or hs-CRP (high-sensitivity C-reactive protein). However, it became nonexistent after adjusting for hemoglobin A1c (β=-0.010, P=0.49). CONCLUSIONS Dynamic contrast-enhanced magnetic resonance imaging of carotid plaques suggested that plaque neovasculature in patients with diabetes is leaky, indicating enhanced capability of bringing blood constituents and facilitating extravasation of inflammatory cells, erythrocytes, and plasma proteins. Leaky plaque neovasculature correlated with hemoglobin A1c and may play a role in accelerated atherosclerosis progression in diabetes.
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Affiliation(s)
- Beibei Sun
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (B.S., X.G., X.L., J.Z., Z.Z., X.L., Y.Z., J.X., H.Z.)
| | - Xiaoqian Ge
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (B.S., X.G., X.L., J.Z., Z.Z., X.L., Y.Z., J.X., H.Z.)
- Department of Radiology, Shandong Second Provincial General Hospital, Jinan, China (X.G.)
| | - Xiao Li
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (B.S., X.G., X.L., J.Z., Z.Z., X.L., Y.Z., J.X., H.Z.)
- Department of Radiology, Shandong Second Provincial General Hospital, Jinan, China (X.G.)
| | - Jianjian Zhang
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (B.S., X.G., X.L., J.Z., Z.Z., X.L., Y.Z., J.X., H.Z.)
| | - Zizhou Zhao
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (B.S., X.G., X.L., J.Z., Z.Z., X.L., Y.Z., J.X., H.Z.)
| | - Xiaosheng Liu
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (B.S., X.G., X.L., J.Z., Z.Z., X.L., Y.Z., J.X., H.Z.)
| | - Yan Zhou
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (B.S., X.G., X.L., J.Z., Z.Z., X.L., Y.Z., J.X., H.Z.)
| | - Jianrong Xu
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (B.S., X.G., X.L., J.Z., Z.Z., X.L., Y.Z., J.X., H.Z.)
| | - Huilin Zhao
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (B.S., X.G., X.L., J.Z., Z.Z., X.L., Y.Z., J.X., H.Z.)
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle (J.S.)
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Dilated microvessel with endothelial cell proliferation involves intraplaque hemorrhage in unstable carotid plaque. Acta Neurochir (Wien) 2021; 163:1777-1785. [PMID: 32995934 DOI: 10.1007/s00701-020-04595-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/22/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The purpose of the present study was to clarify the characteristics of endothelial cell (EC) proliferation in intraplaque microvessels in vulnerable plaques and impact on clinical results. METHODS The present study included 76 patients who underwent carotid endarterectomy. Patients were classified into three groups based on their symptoms: asymptomatic, symptomatic without recurrent ischemic event, and symptomatic with recurrent ischemic event. MR plaque imaging was performed and surgical specimens underwent immunohistochemical analysis. The number of CD31+ microvessels, and Ki67+ and CD105+ ECs in the carotid plaques was quantified, as measurements of maximum CD31+ microvessel diameter. RESULTS MR plaque imaging yielded 41 subjects (54.0%) diagnosed with plaque with intraplaque hemorrhage (IPH), 14 subjects (18.4%) diagnosed with fibrous plaques, and 21 (27.6%) subjects diagnosed with lipid-rich plaques. The average largest diameter of microvessel in fibrous plaques, lipid-rich plaques, and plaque with IPH was 12.7 ± 4.1 μm, 31.3 ± 9.3 μm, and 56.4 ± 10.0 μm, respectively (p < 0.01). Dilated microvessels (>40 μm) were observed in 9.6% of plaques with IPH but only in 2.8% of lipid-rich plaques and 0% of fibrous plaques (p < 0.01). Ki67+/CD31+ ECs were identified in 2.8 ± 1.2% of fibrous plaques, 9.6 ± 6.9% of lipid-rich plaques, and in 19.5 ± 5.9% of plaques with IPH (p < 0.01). The average largest diameter of microvessels in the asymptomatic group was 17.1 ± 8.7 μm, 32.3 ± 10.8 μm in the symptomatic without recurrence group, and 55.2 ± 13.2 μm in the symptomatic with recurrence group (p < 0.01). CONCLUSION Dilated microvessels with proliferative ECs may play a key role in IPH pathogenesis. Furthermore, dilated microvessels are likely related to clinical onset and the recurrence of ischemic events. The purpose of the present study was to clarify the characteristics of EC proliferation in intraplaque microvessels in vulnerable plaques and their impact on clinical results, focusing on dilated intraplaque microvessels.
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Kassem M, Florea A, Mottaghy FM, van Oostenbrugge R, Kooi ME. Magnetic resonance imaging of carotid plaques: current status and clinical perspectives. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1266. [PMID: 33178798 PMCID: PMC7607136 DOI: 10.21037/atm-2020-cass-16] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Rupture of a vulnerable carotid plaque is one of the leading causes of stroke. Carotid magnetic resonance imaging (MRI) is able to visualize all the main hallmarks of plaque vulnerability. Various MRI sequences have been developed in the last two decades to quantify carotid plaque burden and composition. Often, a combination of multiple sequences is used. These MRI techniques have been extensively validated with histological analysis of carotid endarterectomy specimens. High agreement between the MRI and histological measures of plaque burden, intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), fibrous cap (FC) status, inflammation and neovascularization has been demonstrated. Novel MRI sequences allow to generate three-dimensional isotropic images with a large longitudinal coverage. Other new sequences can acquire multiple contrasts using a single sequence leading to a tremendous reduction in scan time. IPH can be easily identified as a hyperintense signal in the bulk of the plaque on strongly T1-weighted images, such as magnetization-prepared rapid acquisition gradient echo images, acquired within a few minutes with a standard neurovascular coil. Carotid MRI can also be used to evaluate treatment effects. Several meta-analyses have demonstrated a strong predictive value of IPH, LRNC, thinning or rupture of the FC for ischemic cerebrovascular events. Recently, in a large meta-analysis based on individual patient data of asymptomatic and symptomatic individuals with carotid artery stenosis, it was shown that IPH on MRI is an independent risk predictor for stroke, stronger than any known clinical risk parameter. Expert recommendations on carotid plaque MRI protocols have recently been described in a white paper. The present review provides an overview of the current status and applications of carotid plaque MR imaging and its future potential in daily clinical practice.
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Affiliation(s)
- Mohamed Kassem
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Alexandru Florea
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Felix M Mottaghy
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Robert van Oostenbrugge
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Neurology, MUMC+, Maastricht, The Netherlands
| | - M Eline Kooi
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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Abstract
OBJECTIVES Embolic ischemic strokes cause significant mortality and morbidity worldwide. It has been proposed that some of these strokes are due to unstable carotid plaques with intraplaque hemorrhage (IPH) but a low overall degree of stenosis. Our aim was to test a fat-saturated T1-weighted (T1WI) black-blood sequence on MRI for the detection of IPH in symptomatic individuals and to quantify the relation between IPH, severity of stenoses, and ischemic brain lesions. MATERIALS AND METHODS Sixty-two patients were examined by 3T MRI. Sequences included brain diffusion-weighted imaging (DWI) as well as 3D turbo spin echo (TSE) fat-saturated black-blood T1 of the carotid bifurcations, to detect IPH as a focal intraplaque hyperintensity. Both carotid arteries were analyzed in each patient. The North American Symptomatic Carotid Endarterectomy Trial scale was used for quantification of stenosis degree. RESULTS Thirty-six out of 62 patients (mean age, 74) showed brain ischemia on DWI. Fifteen of these 36 patients (42%) had associated ipsilateral IPH at the carotid bifurcation or the proximal internal carotid artery. Mean degree of stenosis in this group was 50%. In 21 patients with ischemia without IPH, the mean degree of stenosis was 44%. CONCLUSIONS MRI with 3D TSE fat-saturated black-blood T1 technique is a safe, reliable, and noninvasive tool for the detection of IPH. A high percentage (42%) of ischemic events in patients with low- to moderate-degree stenosis were associated with IPH, an easily detectable imaging biomarker of plaque vulnerability. The ability to confirm IPH by MRI may help stratify patients into different risk and treatment groups in the future.
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Shi X, Gao J, Lv Q, Cai H, Wang F, Ye R, Liu X. Calcification in Atherosclerotic Plaque Vulnerability: Friend or Foe? Front Physiol 2020; 11:56. [PMID: 32116766 PMCID: PMC7013039 DOI: 10.3389/fphys.2020.00056] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/21/2020] [Indexed: 12/23/2022] Open
Abstract
Calcification is a clinical marker of atherosclerosis. This review focuses on recent findings on the association between calcification and plaque vulnerability. Calcified plaques have traditionally been regarded as stable atheromas, those causing stenosis may be more stable than non-calcified plaques. With the advances in intravascular imaging technology, the detection of the calcification and its surrounding plaque components have evolved. Microcalcifications and spotty calcifications represent an active stage of vascular calcification correlated with inflammation, whereas the degree of plaque calcification is strongly inversely related to macrophage infiltration. Asymptomatic patients have a higher content of plaque calcification than that in symptomatic patients. The effect of calcification might be biphasic. Plaque rupture has been shown to correlate positively with the number of spotty calcifications, and inversely with the number of large calcifications. There may be certain stages of calcium deposition that may be more atherogenic. Moreover, superficial calcifications are independently associated with plaque rupture and intraplaque hemorrhage, which may be due to the concentrated and asymmetrical distribution of biological stress in plaques. Conclusively, calcification of differential amounts, sizes, shapes, and positions may play differential roles in plaque homeostasis. The surrounding environments around the calcification within plaques also have impacts on plaque homeostasis. The interactive effects of these important factors of calcifications and plaques still await further study.
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Affiliation(s)
- Xuan Shi
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Jie Gao
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Qiushi Lv
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Haodi Cai
- Department of Neurology, Jinling Hospital, Southeast University, Nanjing, China
| | - Fang Wang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ruidong Ye
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
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Azuma M, Maekawa K, Yamashita A, Yokogami K, Enzaki M, Khant ZA, Takeshima H, Asada Y, Wang Y, Hirai T. Characterization of Carotid Plaque Components by Quantitative Susceptibility Mapping. AJNR Am J Neuroradiol 2019; 41:310-317. [PMID: 31879331 DOI: 10.3174/ajnr.a6374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/14/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Intraplaque hemorrhage in the carotid artery is related to an increased risk of cerebrovascular ischemic events. We aimed to investigate whether quantitative susceptibility mapping can characterize carotid artery plaque components and quantify the severity of intraplaque hemorrhage. MATERIALS AND METHODS For this ex vivo quantitative susceptibility mapping study, 9 carotid endarterectomy specimens were imaged on a 3T MR imaging scanner using a 3D multi-echo gradient-echo sequence and a microscopy coil. The samples were examined histologically using immunostains, including glycophorin A and Prussian blue. The areas of erythrocytes, iron deposits, calcification, and fibrous matrices observed on stained sections were compared with quantitative susceptibility mapping findings and their mean susceptibility values. RESULTS Intraplaque hemorrhage and iron deposits were observed only in areas hyperintense on quantitative susceptibility mapping; calcifications and fibrous matrices were prevalent in hypointense areas. The mean susceptibility values for necrotic cores with intraplaque hemorrhage but no iron deposits, cores with iron deposits but no intraplaque hemorrhage, cores without either intraplaque hemorrhage or iron deposits, and cores with calcification were 188 ± 51, 129 ± 49, -11 ± 17, and -158 ± 78 parts per billion, respectively. There was a significant difference in the mean susceptibility values among the 4 histologic components (P < .01). The mean susceptibility values of the whole plaque positively correlated with the percentage area positive for glycophorin A (r = 0.65, P < .001) and Prussian blue (r = 0.47, P < .001). CONCLUSIONS Our findings suggest that quantitative susceptibility mapping can characterize the composition of carotid plaques and quantify the degree of intraplaque hemorrhage and iron deposits.
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Affiliation(s)
- M Azuma
- From the Departments of Radiology (M.A., Z.A.K., T.H.)
| | | | | | - K Yokogami
- Neurosurgery (K.Y., H.T., Y.A.), Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - M Enzaki
- Radiology Section (M.E.), University of Miyazaki Hospital, Miyazaki, Japan
| | - Z A Khant
- From the Departments of Radiology (M.A., Z.A.K., T.H.)
| | - H Takeshima
- Neurosurgery (K.Y., H.T., Y.A.), Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Y Asada
- Neurosurgery (K.Y., H.T., Y.A.), Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Y Wang
- Department of Radiology (Y.W.), Weill Medical College of Cornell University, New York, New York
| | - T Hirai
- From the Departments of Radiology (M.A., Z.A.K., T.H.)
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Luo L, Liu S, Tong X, Jiang P, Yuan C, Zhao X, Shang F. Carotid artery segmentation using level set method with double adaptive threshold (DATLS) on TOF-MRA images. Magn Reson Imaging 2019; 63:123-130. [DOI: 10.1016/j.mri.2019.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/19/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
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Hori S, Hori E, Shibata T, Umemura K, Okamoto S, Kubo M, Horie Y, Kuroda S. Correlation Between Cerebral Microbleeds and Vulnerable Plaque in Patients with Severe Carotid Artery Stenosis; Comparative Magnetic Resonance Imaging Study. J Stroke Cerebrovasc Dis 2019; 28:104300. [PMID: 31358356 DOI: 10.1016/j.jstrokecerebrovasdis.2019.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/08/2019] [Accepted: 07/13/2019] [Indexed: 02/05/2023] Open
Abstract
GOAL There are an increasing idea that the inflammation contributes to vascular diseases in various organs. The pathogenesis of both cerebral small vessel disease such as cerebral microbleeds and carotid plaque may be associated with chronic inflammation. This study was aimed to evaluate the correlation between microbleeds and carotid plaque characteristics. MATERIALS AND METHODS This study enrolled 85 patients who underwent surgical/endovascular treatments for carotid artery stenosis between January 2009 and July 2016. Their clinical data were precisely analyzed. T2*-weighted magnetic resonance (MR) imaging was performed to detect the cerebral microbleeds. The carotid plaque with high signal intensity on T1-weighted MR imaging was categorized into vulnerable plaque. FINDINGS The microbleeds was detected in 17 of 85 (20%). The prevalence of vulnerable carotid plaque and previous symptomatic lacunar infarction was significantly greater in the patients with microbleeds than in those without (P = .001 and P = .03, respectively). Multiple logistic regression analysis showed that the vulnerable plaque was significantly associated with the presence of microbleeds when adjusted for age, alcohol intake, antiplatelet drug use, the presence of previous symptomatic lacunar infarction, and coronary artery disease (P = .009, OR = 5.38, 95% CI = 1.51-21.0). CONCLUSIONS These findings suggest the correlation between microbleeds and vulnerable plaque in patients with severe (>70%) carotid artery stenosis. Systemic, chronic inflammation may play a key role in both small and large arteries' disease of the brain. The knowledge may be valuable to fully understand the entity of cerebrovascular diseases as one of systemic, chronic inflammation.
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Affiliation(s)
- Satoshi Hori
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan.
| | - Emiko Hori
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Takashi Shibata
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Kimiko Umemura
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Soushi Okamoto
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Michiya Kubo
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Yukio Horie
- Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan
| | - Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan
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Liu Y, Wang M, Zhang B, Wang W, Xu Y, Han Y, Yuan C, Zhao X. Size of carotid artery intraplaque hemorrhage and acute ischemic stroke: a cardiovascular magnetic resonance Chinese atherosclerosis risk evaluation study. J Cardiovasc Magn Reson 2019; 21:36. [PMID: 31262337 PMCID: PMC6604180 DOI: 10.1186/s12968-019-0548-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/30/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To determine the usefulness of the size of carotid artery intraplaque hemorrhage (IPH) in discriminating the risk of acute ischemic stroke using cardiovascular magnetic resonance (CMR) vessel wall imaging. METHODS Symptomatic patients with carotid atherosclerotic plaque who participated in a cross-sectional, multicenter study of CARE-II (NCT02017756) were included. All patients underwent carotid and brain CMR imaging. Carotid plaque burden and the size of plaque compositions including calcification, lipid-rich necrotic core (LRNC), and IPH were measured. Presence of acute cerebral infarct (ACI) in ipsilateral hemisphere of carotid plaque was determined. The relationship between carotid plaque features and presence of ipsilateral ACI was then analyzed. RESULTS Of 687 recruited patients (62.7 ± 10.1 years; 69.4% males) with carotid plaque, 28.5% had ACI in ipsilateral hemispheres. Logistic regression revealed that carotid plaque burden was significantly associated with the presence of ACI before and after adjusted for clinical confounding factors. The volume of LRNC, %LRNC volume, volume of IPH, and %IPH volume were significantly associated with ACI before (volume of LRNC: OR = 1.297, p = 0.005; %LRNC volume: OR = 1.119, p = 0.018; volume of IPH: OR = 2.514, p = 0.003; %IPH volume: OR = 2.202, p = 0.003) and after (volume of LRNC: OR = 1.312, p = 0.006; %LRNC volume: OR = 1.90, p = 0.034; volume of IPH: OR = 2.907, p = 0.007; % IPH volume: OR = 2.374, p = 0.004) adjusted for clinical confounding factors. The association between volume of IPH and ACI remained statistically significant after further adjusted for plaque volume (OR = 2.813, p = 0.016) or both plaque volume and volume of LRNC (OR = 4.044, p = 0.024). CONCLUSIONS In symptomatic patients with carotid atherosclerotic plaques, the size of IPH is independently associated with ipsilateral ACI, suggesting the size of IPH might be a useful indicator for the risk of ACI. TRIAL REGISTRATION Clinical Trial Registration-URL: http://www.clinicaltrials.gov . Unique Identifier: NCT02017756.
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Affiliation(s)
- Yang Liu
- Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou, China
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
| | - Maoxue Wang
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- Department of Medical Imaging, Taikang Xianlin Drum Tower Hospital, Nanjing, China
| | - Bing Zhang
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Wei Wang
- Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Yun Xu
- Department of Neurology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yongjun Han
- Center for Brain Disorders Research, Capital Medical University and Beijing Institute for Brain Disorders, Beijing, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, USA
| | - Xihai Zhao
- Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
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Lu M, Cui Y, Peng P, Qiao H, Cai J, Zhao X. Shape and Location of Carotid Atherosclerotic Plaque and Intraplaque Hemorrhage: A High-resolution Magnetic Resonance Imaging Study. J Atheroscler Thromb 2019; 26:720-727. [PMID: 30626781 PMCID: PMC6711842 DOI: 10.5551/jat.47449] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: The present study aimed to investigate the association between shape and location of atherosclerotic plaques and intraplaque hemorrhage (IPH) in carotid arteries using magnetic resonance (MR) imaging. Methods: Overall, 114 symptomatic patients (mean age: 64.9±10.9 years; 81 males) who underwent MR imaging and had advanced carotid plaques were included in analysis. IPH presence and carotid plaque shape and location (below and above bifurcation) were evaluated. The plaque shape was defined as follows: type-I: the arc-length of plaque is greater in the upstream; type-II: the arc-length of plaque in downstream and upstream is equal; and type-III: the arc-length of plaque is greater in downstream. The plaque shape and location were compared between plaques with and without IPH and their associations with IPH were determined. Results: Of 181detectedplaques, 57 (31.5%) had IPH. Compared with plaques without IPH, those with IPH had higher incidence of the plaque shape of type-I (66.7% vs. 32.2%, P<0.001), lower incidence of plaque shape of type-III (24.6% vs. 50.0%, P=0.001), and were more likely located above carotid bifurcation (71.9% vs. 48.4%, P=0.003). The plaque shape of type-I (OR, 4.01; 95%CI, 1.36–11.83; P=0.012) and location above bifurcation (OR, 3.21; 95%CI, 1.07–9.61; P=0.037) of carotid plaques were significantly associated with IPH after adjusting for confounder factors. Conclusions: Carotid plaque shape and location are significantly associated with the occurrence of IPH. Our findings could provide new insights for the pathogenesis of IPH and vulnerably plaques.
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Affiliation(s)
- Mingming Lu
- Department of Radiology, PLA General Hospital.,Department of Radiology, Pingjin Hospital, Logistics University of Chinese People's Armed Police Forces
| | | | - Peng Peng
- Department of Radiology, Pingjin Hospital, Logistics University of Chinese People's Armed Police Forces
| | - Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine
| | | | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine
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11
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Guo ZY, Zhang B, Yan YH, Gao SS, Liu JJ, Xu L, Hui PJ. Specific matrix metalloproteinases and calcification factors are associated with the vulnerability of human carotid plaque. Exp Ther Med 2018; 16:2071-2079. [PMID: 30186442 DOI: 10.3892/etm.2018.6424] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 04/13/2018] [Indexed: 12/20/2022] Open
Abstract
The rupture of atherosclerotic plaque provokes the majority of acute cerebrovascular events. Studies have demonstrated that various matrix metalloproteinases (MMPs) may promote atherosclerotic plaque progression and rupture. However, results have been incongruous and the mechanisms of this remain obscured. Therefore, in the current study, carotid plaques were characterized by assessing the levels of MMPs and calcification factors, and evaluating their association with plaque vulnerability. Human carotid plaques were obtained from carotid endarterectomies, and classified into stable and vulnerable groups by ultrasonography and histological analyses. The mRNA and protein levels of MMPs, vascular endothelial growth factor (VEGF), bone sialoprotein 2 (BSP) and osteopontin were investigated by reverse transcription-quantitative polymerase chain reaction and western blotting, respectively. Immunohistochemistry was used to localize MMP-2 and MMP-14 in stable and vulnerable plaques. The activation of various associated signaling pathways was also investigated using western blotting. The mRNA levels of MMP-2, -7, -9 and -14 were elevated in vulnerable plaques, among which expression of MMP-2 and -14 were the highest. Consistent with the mRNA levels, the protein levels of MMP-2 and -14 were also elevated. Immunohistochemistry also demonstrated positive staining of MMP-2 and MMP-14 in vulnerable plaques. Factors that indicate neovascularization and calcification, including VEGF and BSP, were concurrently elevated in vulnerable plaques. In addition, the protein levels of extracellular regulated kinase (ERK) and protein kinase C (PKC) were upregulated in vulnerable plaques. The current study provides novel insights into the MMP profiles of vulnerability plaques, and may assist in the development of novel methods for the diagnosis of plaque vulnerability and the prevention of plaque rupture.
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Affiliation(s)
- Zhou-Ying Guo
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China.,Department of Ultrasound, The First Hospital of Lianyungang, Lianyungang, Jiangsu 222000, P.R. China
| | - Bai Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Yan-Hong Yan
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Shang-Shang Gao
- Department of Biochemical and Molecular of Medical College, Soochow University, Suzhou, Jiangsu 215123, P.R. China
| | - Jing-Jing Liu
- Department of Biochemical and Molecular of Medical College, Soochow University, Suzhou, Jiangsu 215123, P.R. China
| | - Lan Xu
- Department of Biochemical and Molecular of Medical College, Soochow University, Suzhou, Jiangsu 215123, P.R. China
| | - Pin-Jing Hui
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
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12
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Heo SH, Lee EH, Park HH, Kim BJ, Youn HC, Kim YS, Kim HY, Koh SH, Chang DI. Differences between the Molecular Mechanisms Underlying Ruptured and Non-Ruptured Carotid Plaques, and the Significance of ABCA1. J Stroke 2018; 20:80-91. [PMID: 29402067 PMCID: PMC5836578 DOI: 10.5853/jos.2017.02390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/02/2018] [Accepted: 01/19/2018] [Indexed: 01/03/2023] Open
Abstract
Background and Purpose Carotid plaques are a strong risk factor for ischemic stroke, and plaque rupture poses an even higher risk. Although many studies have investigated the pathogenic mechanisms of carotid plaque formation, few have studied the differences in molecular mechanisms underlying the rupture and non-rupture of carotid plaques. In addition, since early diagnosis and treatment of carotid plaque rupture are critical for the prevention of ischemic stroke, many studies have sought to identify the important target molecules involved in the rupture. However, a target molecule critical in symptomatic ruptured plaques is yet to be identified. Methods A total of 79 carotid plaques were consecutively collected, and microscopically divided into ruptured and non-ruptured groups. Quantitative polymerase chain reaction array, proteomics, and immunohistochemistry were performed to compare the differences in molecular mechanisms between ruptured and non-ruptured plaques. Enzyme-linked immunosorbent assay was used to measure the differences in ATP-binding cassette subfamily A member 1 (ABCA1) levels in the serum. Results The expression of several mRNAs and proteins, including ABCA1, was higher in ruptured plaques than non-ruptured plaques. In contrast, the expression of other proteins, including β-actin, was lower in ruptured plaques than non-ruptured plaques. The increased expression of ABCA1 was consistent across several experiments, ABCA1 was positive only in the serum of patients with symptomatic ruptured plaques. Conclusions This study introduces a plausible molecular mechanism underlying carotid plaque rupture, suggesting that ABCA1 plays a role in symptomatic rupture. Further study of ABCA1 is needed to confirm this hypothesis.
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Affiliation(s)
- Sung Hyuk Heo
- Department of Neurology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eun-Hye Lee
- Department of Neurology, Hanyang University College of Medicine, Seoul, Korea.,Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science & Engineering, Seoul, Korea
| | - Hyun-Hee Park
- Department of Neurology, Hanyang University College of Medicine, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyo Chul Youn
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Young Seo Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Korea
| | - Hyun Young Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Korea
| | - Seong-Ho Koh
- Department of Neurology, Hanyang University College of Medicine, Seoul, Korea.,Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science & Engineering, Seoul, Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University School of Medicine, Seoul, Korea
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13
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Sun B, Li X, Liu X, Ge X, Lu Q, Zhao X, Pu J, Xu J, Zhao H. Association between carotid plaque characteristics and acute cerebral infarction determined by MRI in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2017; 16:111. [PMID: 28893252 PMCID: PMC5594451 DOI: 10.1186/s12933-017-0592-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) might aggravate the carotid plaque vulnerability, and increase the risk for ischemic stroke. Few studies reported the acute stroke subtype with carotid plaque characteristics in T2DM patients. This study aimed to investigate the association between carotid plaque characteristics and acute cerebral infarct (ACI) lesion features determined by MRI in T2DM patients. METHODS Patients with acute cerebrovascular syndrome in internal carotid artery territory were recruited. All patients were stratified into T2DM and non-T2DM groups and underwent both carotid and brain MRI scans. Ipsilateral carotid plaque morphological and compositional characteristics, intracranial and extracranial carotid artery stenosis were also determined. Stroke subtype based on the Trial of ORG 10172 in Acute Stroke Treatment classification and ACI lesion patterns were evaluated. RESULTS Of the recruited 140 patients, 68 (48.6%) patients had T2DM (mean age 64.16 ± 11.38 years, 40 males). T2DM patients exhibited higher prevalence of carotid type IV-VI lesions, larger plaque burden as well as larger lipid-rich necrotic core (LRNC) compared with non-T2DM patients. Among the patients with carotid LRNC on symptomatic side, more concomitant large perforating artery infarct patterns and larger ACI size in the internal carotid artery territory were found in T2DM group than those in non-T2DM group. Carotid plaque with LRNC% > 22.0% was identified as an independent risk factor for the presence of ACI lesions confined to the carotid territory in T2DM patients, regardless of other risk factors. CONCLUSIONS This study shows that more concomitant large perforating artery infarct patterns and larger ACI size in the internal carotid artery territory were found in the T2DM patients with ipsilateral carotid LRNC plaque than those in non-T2DM patients. Quantification of the carotid plaque characteristics, particularly the LRNC% by MRI has the potential usefulness for stroke risk stratification.
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Affiliation(s)
- Beibei Sun
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Xiao Li
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Xiaosheng Liu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China.
| | - Xiaoqian Ge
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Qing Lu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China.
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China.
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14
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Cao Y, Sun Y, Zhou B, Zhao H, Zhu Y, Xu J, Liu X. Atherosclerotic plaque burden of middle cerebral artery and extracranial carotid artery characterized by MRI in patients with acute ischemic stroke in China: association and clinical relevance. Neurol Res 2017; 39:344-350. [PMID: 28136710 DOI: 10.1080/01616412.2017.1281196] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study sought to compare the atherosclerotic plaque burden between middle cerebral artery (MCA) and extracranial carotid artery (ECA) in ischemic stroke patients using high-resolution, black-blood (HR BB) MRI and to investigate the relationship between plaque burden found in both arteries and stroke severity. METHODS All subjects with recent ischemic stroke underwent MCA and ECA HR BB MRI at 3.0 Tesla. For each artery segment, the thickness, area and signal intensities of plaques were recorded. Plaque burden, as measured by normalized wall index (NWI = wall area/total vessel area × 100%) were calculated. All patients received a clinical stroke severity score as measured by the National Institutes of Health Stroke Scale (NIHSS) scores at the time of admission. RESULTS A total of 65 stroke subjects were included in the final analysis. MCA exhibited significantly greater NWI than the ipsilateral ECA (symptomatic MCA vs. ECA: 58.04 ± 8.19 vs. 37.53 ± 10.25, p < 0.001; asymptomatic MCA vs. ECA: 53.80 ± 4.49 vs. 34.85 ± 4.27, p < 0.001, respectively). NWI in symptomatic MCA and ECA were significantly associated with NIHSS scores (r = 0.779 vs. 0.645; p < 0.001 respectively). Moreover, stronger statistical correlations between NIHSS scores and NWI were found in MCA, as compared with ECA during multivariate linear regression analysis. CONCLUSION Greater atherosclerotic plaque burden and a closer association with stroke severity were found for the MCA as compared to the ipsilateral ECA. Identification of MCA plaque lesions by MRI may be helpful for developing more aggressive strategies for stroke prevention.
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Affiliation(s)
- Ye Cao
- a Department of Radiology , Renji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yi Sun
- a Department of Radiology , Renji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Bin Zhou
- a Department of Radiology , Renji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Huilin Zhao
- a Department of Radiology , Renji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Ying Zhu
- b Department of Neurology , Renji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Jianrong Xu
- a Department of Radiology , Renji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Xiaosheng Liu
- a Department of Radiology , Renji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
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15
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Liu J, Zhu Y, Wu Y, Liu Y, Teng Z, Hao Y. Association of carotid atherosclerosis and recurrent cerebral infarction in the Chinese population: a meta-analysis. Neuropsychiatr Dis Treat 2017; 13:527-533. [PMID: 28260898 PMCID: PMC5325114 DOI: 10.2147/ndt.s124386] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Stroke, when poor blood flow to the brain results in cell death, is the third leading cause of disability and mortality worldwide, and appears as an unequal distribution in the global population. The cumulative risk of recurrence varies greatly up to 10 years after the first stroke. Carotid atherosclerosis is a major risk factor for stroke. The aim of this study was to investigate and estimate the relationship between carotid atherosclerosis and risk of stroke recurrence in the Chinese population. We performed a systematic review and meta-analysis of randomized controlled trials published from 2000 to 2013, using the following databases: PubMed, Embase, Medline, Wanfang, and the China National Knowledge Infrastructure. The odds ratios with 95% confidence intervals were calculated to examine this strength. A total of 22 studies, including 3,912 patients, 2,506 first-ever cases, and 1,406 recurrent cases, were pooled in this meta-analysis. Our results showed that the frequency of carotid atherosclerosis is higher in recurrent cases than that in the first-ever controls (78.88% vs 59.38%), and the statistical analysis demonstrated significant positive association between carotid atherosclerosis and recurrent cerebral infarction (odds ratio: 2.87; 95% confidence interval: 2.42-3.37; P<0.00001) in a fixed-effect model. No significant heterogeneity was observed across all studies. In conclusion, our results showed that carotid atherosclerosis was associated with increased risk of recurrent stroke. However, further well-designed research with large sample sizes is still needed to identify the clear mechanism.
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Affiliation(s)
- Jianping Liu
- Department of Science and Education, Nephrology, Orthopedic and Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, People's Republic of China
| | - Yun Zhu
- Department of Science and Education, Nephrology, Orthopedic and Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, People's Republic of China
| | - Yuhuai Wu
- Department of Science and Education, Nephrology, Orthopedic and Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, People's Republic of China
| | - Yan Liu
- Department of Science and Education, Nephrology, Orthopedic and Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, People's Republic of China
| | - Zhaowei Teng
- Department of Science and Education, Nephrology, Orthopedic and Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, People's Republic of China
| | - Yinglu Hao
- Department of Science and Education, Nephrology, Orthopedic and Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, People's Republic of China
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16
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Preoperative 3D FSE T1-Weighted MR Plaque Imaging for Severely Stenotic Cervical ICA: Accuracy of Predicting Emboli during Carotid Endarterectomy. Int J Mol Sci 2016; 17:ijms17111791. [PMID: 27801780 PMCID: PMC5133792 DOI: 10.3390/ijms17111791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/09/2016] [Accepted: 10/17/2016] [Indexed: 11/22/2022] Open
Abstract
The aim of the present study was to determine whether preoperative three-dimensional (3D) fast spin-echo (FSE) T1-weighted magnetic resonance (MR) plaque imaging for severely stenotic cervical carotid arteries could accurately predict the development of artery-to-artery emboli during exposure of the carotid arteries in carotid endarterectomy (CEA). Seventy-five patients underwent preoperative MR plaque imaging and CEA under transcranial Doppler ultrasonography of the ipsilateral middle cerebral artery. On reformatted axial MR image slices showing the maximum plaque occupation rate (POR) and maximum plaque intensity for each patient, the contrast ratio (CR) was calculated by dividing the internal carotid artery plaque signal intensity by the sternocleidomastoid muscle signal intensity. For all patients, the area under the receiver operating characteristic curve (AUC)—used to discriminate between the presence and absence of microembolic signals—was significantly greater for the CR on the axial image with maximum plaque intensity (CRmax intensity) (0.941) than for that with the maximum POR (0.885) (p < 0.05). For 32 patients in whom both the maximum POR and the maximum plaque density were identified, the AUCs for the CR were 1.000. Preoperative 3D FSE T1-weighted MR plaque imaging accurately predicts the development of artery-to-artery emboli during exposure of the carotid arteries in CEA.
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17
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Sato Y, Ogasawara K, Narumi S, Sasaki M, Saito A, Tsushima E, Namba T, Kobayashi M, Yoshida K, Terayama Y, Ogawa A. Optimal MR Plaque Imaging for Cervical Carotid Artery Stenosis in Predicting the Development of Microembolic Signals during Exposure of Carotid Arteries in Endarterectomy: Comparison of 4 T1-Weighted Imaging Techniques. AJNR Am J Neuroradiol 2016; 37:1146-54. [PMID: 26846926 DOI: 10.3174/ajnr.a4674] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/27/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Preoperative identification of plaque vulnerability may allow improved risk stratification for patients considered for carotid endarterectomy. The present study aimed to determine which plaque imaging technique, cardiac-gated black-blood fast spin-echo, magnetization-prepared rapid acquisition of gradient echo, source image of 3D time-of-flight MR angiography, or noncardiac-gated spin-echo, most accurately predicts development of microembolic signals during exposure of carotid arteries in carotid endarterectomy. MATERIALS AND METHODS Eighty patients with ICA stenosis (≥70%) underwent the 4 sequences of preoperative MR plaque imaging of the affected carotid bifurcation and then carotid endarterectomy under transcranial Doppler monitoring of microembolic signals in the ipsilateral middle cerebral artery. The contrast ratio of the carotid plaque was calculated by dividing plaque signal intensity by sternocleidomastoid muscle signal intensity. RESULTS Microembolic signals during exposure of carotid arteries were detected in 23 patients (29%), 3 of whom developed new neurologic deficits postoperatively. Those deficits remained at 24 hours after surgery in only 1 patient. The area under the receiver operating characteristic curve to discriminate between the presence and absence of microembolic signals during exposure of the carotid arteries was significantly greater with nongated spin-echo than with black-blood fast spin-echo (difference between areas, 0.258; P < .0001), MPRAGE (difference between areas, 0.106; P = .0023), or source image of 3D time-of-flight MR angiography (difference between areas, 0.128; P = .0010). Negative binomial regression showed that in the 23 patients with microembolic signals, the contrast ratio was associated with the number of microembolic signals only in nongated spin-echo (risk ratio, 1.36; 95% confidence interval, 1.01-1.97; P < .001). CONCLUSIONS Nongated spin-echo may predict the development of microembolic signals during exposure of the carotid arteries in carotid endarterectomy more accurately than other MR plaque imaging techniques.
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Affiliation(s)
- Y Sato
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - K Ogasawara
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - S Narumi
- Neurology and Gerontology (S.N., A.S., Y.T.)
| | - M Sasaki
- Division of Ultra-High Field MRI and Department of Radiology (M.S.), Iwate Medical University School of Medicine, Morioka, Japan
| | - A Saito
- Neurology and Gerontology (S.N., A.S., Y.T.)
| | - E Tsushima
- Graduate School of Health Sciences (E.T.), Hirosaki University, Hirosaki, Japan
| | - T Namba
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - M Kobayashi
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - K Yoshida
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
| | - Y Terayama
- Neurology and Gerontology (S.N., A.S., Y.T.)
| | - A Ogawa
- From the Departments of Neurosurgery (Y.S., K.O., T.N., M.K., K.Y., A.O.)
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18
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Li J, Mi D, Pu Y, Zou X, Pan Y, Soo Y, Leung T, Wang Y, Wong KS, Liu L. Comparison of carotid atherosclerotic plaque characteristics between patients with first-time and recurrent acute ischaemic stroke using B-mode ultrasound. Neurol Res 2015; 37:1-5. [PMID: 26100248 DOI: 10.1179/1743132815y.0000000064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The differences between initial and recurrent stroke plaques are not defined. Hence, a nested case-control study was conducted to evaluate the association of stroke recurrence with the echogenic characteristics of carotid plaques in patients with ischaemic stroke. METHODS One hundred and four patients with 1-year recurrent acute ischaemic stroke were enrolled and compared with 104 control patients (first-time ischaemic stroke) matched for age, gender, stroke severity and treatment allocation. Based on the Mannheim Carotid Intima-Media Thickness Consensus (2004-2006), the number of carotid plaques and echogenicity between the two groups of patients were compared. RESULTS As compared to patients with first-time stroke, those with recurrent stroke showed significantly higher prevalence of heart disease (13.46 vs 28.85%, P = 0.0066) and presence of intracranial stenosis (55.77 vs 89.90%, P < 0.0001). During the 1-year follow-up, patients with recurrent stroke had a significantly higher rate of unstable plaques (80.41%) than patients with first-time stroke (64.21%, P = 0.036). Also, patients with recurrent stroke had a significantly larger number of plaques than patients with first-time stroke (P = 0.0152). Multivariate conditional logistic regression analysis (after adjustment for heart disease and intracranial stenosis) identified an association between 1-year stroke recurrence and the presence of unstable plaques (hazard ratio 3.077; 95% CI: 1.133-8.355). CONCLUSION Stroke recurrence is related to advanced atherosclerosis defined by carotid plaque and its characteristics.
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Affiliation(s)
- Jin Li
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China
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19
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Kashiwazaki D, Akioka N, Kuwayama N, Noguchi K, Tanaka K, Kuroda S. Pathophysiology of Acute Cerebrovascular Syndrome in Patients With Carotid Artery Stenosis. Neurosurgery 2015; 76:427-33; discussion 433-4. [DOI: 10.1227/neu.0000000000000655] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
BACKGROUND:
The mechanisms underlying acute cerebrovascular syndrome in patients with carotid artery stenosis remain unclear.
OBJECTIVE:
To assess the relationships among infarct localization, hemodynamics, and plaque components.
METHODS:
This prospective study included 38 patients with acute cerebrovascular syndrome resulting from ipsilateral carotid artery stenosis. Cerebral infarct localization was categorized into 3 patterns (cortical, border zone, and mixed pattern). Carotid plaque components were evaluated with T1-weighted magnetic resonance imaging and time-of-flight imaging. Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) were also quantified.
RESULTS:
Infarcts were identified in 38 patients with the use of diffusion-weighted magnetic resonance imaging. On the basis of the assessment of hemodynamics, the cortical pattern was seen in 18 of 21 patients with type 1 ischemia (normal CBF, normal CVR), whereas the mixed pattern was seen in 2 patients with type 2 ischemia (normal CBF, impaired CVR) and 12 of 15 patients with type 3 ischemia (impaired CBF, impaired CVR). The plaque components were categorized into fibrous (4 patients), lipid-rich (14 patients), and intraplaque hemorrhage (IPH; 20 patients). Of the patients with fibrous plaque, 2 had border-zone and 2 had mixed-pattern infarcts. Of the patients with lipid-rich plaque, 7 had cortical and 6 had mixed-pattern infarcts. Of patients with intraplaque hemorrhage, 11 had cortical and 9 had mixed-pattern infarcts.
CONCLUSION:
Cortical infarction occurs as a result of vulnerable plaque. Reduced cerebral perfusion induces border-zone infarction. Both factors are implicated in mixed-pattern infarction. Developments in noninvasive diagnostic modalities allow us to explore the mechanisms behind acute cerebrovascular syndrome in carotid artery stenosis and to determine the ideal therapies.
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Affiliation(s)
| | | | | | - Kyo Noguchi
- Radiology, Graduate School of Medicine and Pharmacological Science, University of Toyama, Toyama, Japan
| | - Kortaro Tanaka
- Department of Neurology, Toyama University Hospital, Toyama, Japan
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