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(Stroke. 2006;37:818.)
© 2006 American Heart Association, Inc.

Original Contributions

Association Between Carotid Plaque Characteristics and Subsequent Ischemic Cerebrovascular Events

A Prospective Assessment With MRI—Initial Results

Norihide Takaya, MD, PhD; Chun Yuan, PhD; Baocheng Chu, MD, PhD; Tobias Saam, MD; Hunter Underhill, MD; Jianming Cai, MD; Nam Tran, MD; Nayak L. Polissar, PhD; Carol Isaac, RVT; Marina S. Ferguson, MT; Gwenn A. Garden, MD, PhD; Steven C. Cramer, MD; Kenneth R. Maravilla, MD; Beverly Hashimoto, MD Thomas S. Hatsukami, MD

From the Department of Radiology (N.T., C.Y., B.C., T.S., H.U., J.C., M.S.F., K.R.M.), University of Washington, Seattle; Department of Cardiology (N.T.), Juntendo University School of Medicine, Tokyo, Japan; Department of Surgery (N.T., C.I., T.S.H.), University of Washington, Seattle; Mountain-Whisper-Light Statistical Consulting (N.L.P.), Seattle, Wash; Department of Neurology (G.A.G.), University of Washington, Seattle; Department of Neurology (S.C.C.), University of California, Irvine; Department of Radiology (B.H.), Virginia Mason Medical Center, Seattle, Wash; and VA Puget Sound Health Care System (T.S.H.), Seattle, Wash.

Correspondence to Thomas S. Hatsukami, MD, VA Puget Sound Health Care System, Surgery and Perioperative Care (112), 1660 S Columbian Way, Seattle, WA 98108. E-mail tomhat{at}u.washington.edu

Background and Purpose— MRI is able to quantify carotid plaque size and composition with good accuracy and reproducibility and provides an opportunity to prospectively examine the relationship between plaque features and subsequent cerebrovascular events. We tested the hypothesis that the characteristics of carotid plaque, as assessed by MRI, are possible predictors of future ipsilateral cerebrovascular events.

Methods— A total of 154 consecutive subjects who initially had an asymptomatic 50% to 79% carotid stenosis by ultrasound with 12 months of follow-up were included in this study. Multicontrast-weighted carotid MRIs were performed at baseline, and participants were followed clinically every 3 months to identify symptoms of cerebrovascular events.

Results— Over a mean follow-up period of 38.2 months, 12 carotid cerebrovascular events occurred ipsilateral to the index carotid artery. Cox regression analysis demonstrated a significant association between baseline MRI identification of the following plaque characteristics and subsequent symptoms during follow-up: presence of a thin or ruptured fibrous cap (hazard ratio, 17.0; P0.001), intraplaque hemorrhage (hazard ratio, 5.2; P=0.005), larger mean intraplaque hemorrhage area (hazard ratio for 10 mm² increase, 2.6; P=0.006), larger maximum %lipid-rich/necrotic core (hazard ratio for 10% increase, 1.6; P=0.004), and larger maximum wall thickness (hazard ratio for a 1-mm increase, 1.6; P=0.008).

Conclusions— Among patients who initially had an asymptomatic 50% to 79% carotid stenosis, arteries with thinned or ruptured fibrous caps, intraplaque hemorrhage, larger maximum %lipid-rich/necrotic cores, and larger maximum wall thickness by MRI were associated with the occurrence of subsequent cerebrovascular events. Findings from this prospective study provide a basis for larger multicenter studies to assess the risk of plaque features for subsequent ischemic events.

Key Words: atherosclerosis • carotid arteries • cerebrovascular disorders • magnetic resonance imaging

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