carotid_intraplaque_hemorrhage

Carotid intraplaque hemorrhage

“Vulnerable” plaques are atherosclerotic plaques likely to cause thrombotic complications or those that tend to progress rapidly. Criteria for vulnerable plaques include intimal thickening, plaque fissure, lipid/necrotic core with thin fibrous cap, calcification, thrombus, intraplaque hemorrhage, and outward remodeling. Some of these features can be identified with high-resolution MRI 1) 2) 3) 4)

There is a lack of information on the natural history of asymptomatic carotid artery stenosis (AsymCS) associated with cardiovascular diseases that require surgery. The aim of a study was to investigate risk factors for postoperative ipsilateral ischemic stroke and all-cause mortality after cardiovascular surgery in patients with AsymCS.

Among 2158 patients who underwent cardiovascular surgery, 150 patients with AsymCS who didn't undergo carotid revascularization were included. The relationships between preoperative factors, including carotid intraplaque hemorrhage (IPH), and postoperative ipsilateral ischemic stroke and all-cause mortality were analyzed retrospectively.

During the median follow-up of 1087 days of 150 patients with 19 IPH, 12 (8.0%) and 21 (14.0%) encountered ipsilateral infarction and all-cause mortality, respectively. Multivariable Cox regression analyses indicated that IPH was significantly predictive of both ipsilateral infarction (hazard ratio [HR] 21.31, 95% confidence interval [CI], 4.98-91.17; P ≤.001) and all-cause mortality (HR 4.64, 95% CI, 1.61-13.34; P = .004). Another significant factor was peak systolic velocity for ipsilateral infarction with the cutoff velocity of 227 cm/s by the receiver-operating characteristic curve.

In this cohort of patients with AsymCS undergoing cardiovascular surgery, IPH had a close connection with a high risk of both postoperative ischemic stroke and mortality after cardiovascular surgery 5).

References

1)
Cai JM, Hatsukami TS, Ferguson MS, Small R, Polissar NL, Yuan C. Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging. Circulation. 2002; 106:1368–1373
2)
Saam T, Cai J, Ma L, Cai YQ, Ferguson MS, Polissar NL, Hatsukami TS, Yuan C. Comparison of symptomatic and asymptomatic atherosclerotic carotid plaque features with in vivo MR imaging. Radiology. 2006; 240:464–472
3)
Saam T, Hatsukami TS, Takaya N, Chu B, Underhill H, Kerwin WS, Cai J, Ferguson MS, Yuan C. The vulnerable, or high-risk, atherosclerotic plaque: noninvasive MR imaging for characterization and assessment. Radiology. 2007; 244:64–77
4)
Nighoghossian N, Derex L, Douek P. The vulnerable carotid artery plaque: current imaging methods and new perspectives. Stroke. 2005; 36:2764–2772
5)
Misaki K, Uno T, Nambu I, Kimura R, Yoshikawa A, Kamide T, Hayashi Y, Uchiyama N, Iino K, Takemura H, Nakada M. Asymptomatic carotid intraplaque hemorrhage is associated with a high risk of cerebral infarction and death after cardiovascular surgery. J Neurol Sci. 2020 Mar 26;412:116801. doi: 10.1016/j.jns.2020.116801. [Epub ahead of print] PubMed PMID: 32240969.
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