This Article Full Text Full Text (PDF) All Versions of this Article: 38/5/1633    most recent STROKEAHA.106.473066v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Altaf, N. Articles by Auer, D. P. Search for Related Content PubMed PubMed Citation Articles by Altaf, N. Articles by Auer, D. P. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections CT and MRI Carotid Stenosis Carotid endarterectomy

(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

This article has been cited by other articles:

				C. Oppenheim, O. Naggara, E. Touze, J.-C. Lacour, E. Schmitt, F. Bonneville, S. Crozier, E. Guegan-Massardier, E. Gerardin, X. Leclerc, et al. High-Resolution MR Imaging of the Cervical Arterial Wall: What the Radiologist Needs to Know RadioGraphics, September 1, 2009; 29(5): 1413 - 1431. [Abstract] [Full Text] [PDF]

				N. Singh, A. R. Moody, D. J. Gladstone, G. Leung, R. Ravikumar, J. Zhan, and R. Maggisano Moderate Carotid Artery Stenosis: MR Imaging-depicted Intraplaque Hemorrhage Predicts Risk of Cerebrovascular Ischemic Events in Asymptomatic Men Radiology, August 1, 2009; 252(2): 502 - 508. [Abstract] [Full Text] [PDF]

				Z.-S. Shi, L. Feng, X. He, A. Ishii, J. Goldstine, H.V. Vinters, and F. Vinuela Vulnerable Plaque in a Swine Model of Carotid Atherosclerosis AJNR Am. J. Neuroradiol., March 1, 2009; 30(3): 469 - 472. [Abstract] [Full Text] [PDF]

				G. Korosoglou, R. G. Weiss, D. A. Kedziorek, P. Walczak, W. D. Gilson, M. Schar, D. E. Sosnovik, D. L. Kraitchman, R. C. Boston, J. W.M. Bulte, et al. Noninvasive Detection of Macrophage-Rich Atherosclerotic Plaque in Hyperlipidemic Rabbits Using "Positive Contrast" Magnetic Resonance Imaging J. Am. Coll. Cardiol., August 5, 2008; 52(6): 483 - 491. [Abstract] [Full Text] [PDF]

				J M U-King-Im, T Y Tang, A Patterson, M J Graves, S Howarth, Z-Y Li, R Trivedi, D Bowden, P J Kirkpatrick, M E Gaunt, et al. Characterisation of carotid atheroma in symptomatic and asymptomatic patients using high resolution MRI J. Neurol. Neurosurg. Psychiatry, August 1, 2008; 79(8): 905 - 912. [Abstract] [Full Text] [PDF]

				C. von zur Muhlen, D. von Elverfeldt, J.A. Moeller, R.P. Choudhury, D. Paul, C.E. Hagemeyer, M. Olschewski, A. Becker, I. Neudorfer, N. Bassler, et al. Magnetic Resonance Imaging Contrast Agent Targeted Toward Activated Platelets Allows In Vivo Detection of Thrombosis and Monitoring of Thrombolysis Circulation, July 15, 2008; 118(3): 258 - 267. [Abstract] [Full Text] [PDF]

				N. Altaf, P. S. Morgan, A. Moody, S. T. MacSweeney, J. R. Gladman, and D. P. Auer Brain White Matter Hyperintensities Are Associated with Carotid Intraplaque Hemorrhage Radiology, July 1, 2008; 248(1): 202 - 209. [Abstract] [Full Text] [PDF]

				R. M. Kwee, R. J. van Oostenbrugge, L. Hofstra, G. J. Teule, J.M.A. van Engelshoven, W. H. Mess, and M. E. Kooi Identifying vulnerable carotid plaques by noninvasive imaging Neurology, June 10, 2008; 70(24_Part_2): 2401 - 2409. [Abstract] [Full Text] [PDF]

				T. Y. Tang, S. P. Howarth, S. R. Walsh, M. E. Gaunt, and J. H. Gillard Contralateral Carotid Intraplaque Hemorrhage May Reduce the Predictive Value of Fat-Suppressed T1-Weighted MRI in Symptomatic Carotid Disease Stroke, December 1, 2007; 38(12): e156 - e157. [Full Text] [PDF]

				N.-K. Hsieh and H. I. Chen Interacting Leukocytes Predict Atherosclerosis and Restenosis Stroke, December 1, 2007; 38(12): e162 - e163. [Full Text] [PDF]

				J. Golledge Response to Letter by Tang et al Stroke, December 1, 2007; 38(12): e158 - e159. [Full Text] [PDF]

				N. Altaf, S. T. MacSweeney, J. Gladman, and D. P Auer Response to Letters by Hsieh and Chen, and by Tang et al Stroke, December 1, 2007; 38(12): e160 - e161. [Full Text] [PDF]