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(Stroke. 2007;38:1633.)
© 2007 American Heart Association, Inc.

Research Reports

Carotid Intraplaque Hemorrhage Predicts Recurrent Symptoms in Patients With High-Grade Carotid Stenosis

Nishath Altaf, MRCS(Ed); Shane T. MacSweeney, FRCS; John Gladman, FRCP Dorothee P. Auer, PhD

From the Department of Academic Radiology (N.A., D.P.A.), University of Nottingham, Queen’s Medical Centre, Nottingham, UK; the Department of Vascular and Endovascular Surgery (N.A., S.T.M.), Queen’s Medical Centre, Nottingham, UK; and the Division of Rehabilitation and Ageing (J.G.), University of Nottingham, Queen’s Medical Centre, Nottingham, UK.

Correspondence to Nishath Altaf, MRCS(Ed), Department of Academic Radiology, University of Nottingham, Queen’s Medical Centre, Nottingham, UK. E-mail nish.altaf{at}nottingham.ac.uk

Background and Purpose— Carotid intraplaque hemorrhage (IPH), known to be associated with plaque instability, may convey a higher stroke risk. The aim of this study was to assess whether the identification of IPH by MRI predicts recurrent clinical cerebrovascular events.

Methods— Sixty-six patients with high-grade symptomatic carotid stenosis underwent MRI of the carotid arteries and were followed until carotid endarterectomy or 30 days.

Results— Of the 66 patients with a median follow up of 33.5 days, 44 (66.7%) were found on MRI to have ipsilateral carotid IPH. Fifteen recurrent events were associated with ipsilateral carotid IPH. Only 2 recurrent events occurred in the absence of IPH. IPH increased the risk of recurrent ischemia (hazard ratio=4.8; 95% CI=1.1 to 20.9, P<0.05).

Conclusion— IPH as detected by MRI predicts recurrent cerebrovascular events in patients with symptomatic high-grade carotid stenosis.

Key Words: carotid artery disease • ischemia • magnetic resonance imaging

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