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Atherosclerotic plaque locations may be related to different ischemic lesion patterns.

ABSTRACT: BACKGROUND:Atherosclerosis of the internal carotid artery (ICA) is an important cause of ischemic stroke. Artery-to-artery embolism is the major stroke mechanism in patients with atherosclerotic carotid disease. This study hypothesized that the atherosclerotic ICA geometry and plaque location would be associated with lesion pattern in patients with acute ischemic stroke. METHODS:Ischemic stroke patients with symptomatic proximal ICA disease (>?50% diameter stenosis) were enrolled. The carotid plaque location was divided into high-apical and low-body types. The geometric parameters of the ICA (angles between arteries) were measured, and ischemic lesion patterns were classified according to the number, location, and size of the lesions. Factors associated with plaque location and lesion pattern, dichotomized by size, were investigated. RESULTS:Of the 93 acute ischemic stroke patients enrolled, 31 had high-apical and 62 had low-body plaques. Hyperlipidemia was more prevalent and the common carotid artery (CCA)-ICA angle was wider (167.7?±?10.4° vs 162.3?±?9.8°, p?=?0.019) in patients with low-body than high-apical plaques. Low-body plaques were more frequently associated with small scattered or cortical lesions (54.8% vs. 32.3%, p?=?0.040), whereas high-apical plaques were more frequently associated with large lesions having additional lesions (38.7% vs. 11.3%, p?=?0.002). The presence of low-body plaques (odds ratio: 3.106, 95% confidence interval: 1.105-8.728, p?=?0.032) was independently associated with the small lesion-only pattern. CONCLUSIONS:Low-body plaques are more frequently associated with small scattered lesions, whereas high-apical plaques are more frequently associated with large lesions having additional lesions. A wide CCA-ICA angle is associated with low-body plaque of the carotid artery.

SUBMITTER: Woo HG

PROVIDER: S-EPMC7391573 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Atherosclerotic plaque locations may be related to different ischemic lesion patterns.

Woo Ho Geol HG Heo Sung Hyuk SH Kim Eui Jong EJ Chang Dae-Il DI Song Tae Jin TJ Kim Bum Joon BJ

BMC neurology 20200730 1

<h4>Background</h4>Atherosclerosis of the internal carotid artery (ICA) is an important cause of ischemic stroke. Artery-to-artery embolism is the major stroke mechanism in patients with atherosclerotic carotid disease. This study hypothesized that the atherosclerotic ICA geometry and plaque location would be associated with lesion pattern in patients with acute ischemic stroke.<h4>Methods</h4>Ischemic stroke patients with symptomatic proximal ICA disease (> 50% diameter stenosis) were enrolled. ...[more]

PMID: 32731859

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Project description:BackgroundPatients with intracranial atherosclerotic disease (ICAD) have a high frequency of stroke recurrence. However, there has been little investigation into the prognostic value of higher-resolution magnetic resonance imaging (HR-MRI).PurposeTo investigate the use of intracranial atherosclerotic plaques features in predicting risk of recurrent cerebrovascular ischemic events using HR-MRI.Study typeProspective.PopulationFifty-eight patients with acute/subacute stroke (N = 46) or transient ischemic attack (N = 12).Field strength/sequenceA 3.0 T, 3D time-of-flight gradient echo sequence and T1- and T2-weighted fast spin echo sequences with 0.31 x 0.39 mm2 in-plane resolution, twice (with >3 months between scans) following the initial event.AssessmentPatients were also followed clinically for recurrent ischemic events for up to 48 months or until a subsequent event occurred. The degree of stenosis, plaque burden (PB), minimal lumen area (MLA), and contrast enhancement ratio were assessed at each scanning session and the percentage change of each over time was calculated.Statistical testsUnivariable and multivariable Cox regression analyses were used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for predicting recurrent events.ResultsThe mean time interval between baseline and follow-up MRI scans was 6.2 ± 4.1 months. After the second MRI scan, 20.7% of patients (N = 12) had experienced ipsilateral recurrent TIA/stroke within 10.9 ± 9.2 months. Univariable analyses showed that baseline triglyceride, percentage change of PB, and progression of PB were significantly associated with recurrent events (all P < 0.05). Multivariable Cox regression indicated that progression of PB (HR, 6.293; 95% CI, 1.620-24.444; P < 0.05) was a significant independent imaging feature for recurrent ischemic events.Data conclusionProgression of PB was independently associated with recurrent ischemic cerebrovascular events. HR-MRI may help risk stratification of patients at risk of recurrent stroke.Level of evidence2 TECHNICAL EFFICACY: Stage 4.

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Atherosclerotic plaque locations may be related to different ischemic lesion patterns.

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Atherosclerotic plaque locations may be related to different ischemic lesion patterns.

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