Abstract T P94: Association Between Carotid Expansive Remodeling Determined by Long-axis High-resolution MRI and Unstable Clinical Presentation
Background and Purpose: Accumulating evidence from recent vascular biology studies has demonstrated that not only luminal narrowing but also plaque characteristics have large impact on the risk of ischemic events. The impact of expansive remodeling (ER) in atherosclerotic arterial disease on unstable clinical presentation has been extensively investigated in coronary circulation. The purpose of the present study was to investigate the association between carotid ER determined by MRI and cerebral ischemic events.
Methods: Among prospectively collected data for patients with carotid artery (CA) stenosis scheduled for carotid endarterectomy (CEA) or carotid stenting, 122 CAs in 119 patients were identified. Excluding 22 CAs (contraindicated for MRI due to pacemaker implantation: 2, near-occlusion: 8, inadequate MRI due to poor image quality: 6, restenosis after CEA or CAS: 6), 100 CAs were finally analyzed in this study. The study included 50 symptomatic (73.6 ± 8.9 years; 6 female; %stenosis, 68.5± 21.3; 34 CEA) and 50 asymptomatic lesions (72.0 ± 5.9 years; 5 female; %stenosis, 79.4 ± 8.85; 15 CEA). ER ratio was calculated by dividing the maximal outside diameter at atherosclerotic plaque near the carotid bulb by the maximal outside diameter of the normal internal CA distal to the plaque with use of long-axis high-resolution MRI.
Results: In 25 patients with unilateral carotid atherosclerosis, the ER ratio of atherosclerotic CA (1.68±0.40) was significantly greater (p<.01) than that of the normal physiological expansion at a carotid bulb (1.36±0.15). The ER ratio of symptomatic CAs (1.93±0.44) was significantly greater (p<0.0001) than that of asymptomatic CAs (1.63±0.30). When the cutoff value was set as 1.88, sensitivity and specificity were 0.6 and 0.78, respectively. The ER ratio of symptomatic CAs was consistently high regardless of % luminal stenosis.
Conclusions: ER ratio measured with MRI might help to establish more accurate risk stratification for future cerebral ischemic events.
Author Disclosures: K. Yoshida: None.
- © 2014 by American Heart Association, Inc.