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Abstract
BackgroundBased on intravascular ultrasound of the coronary arteries expansive arterial remodeling is supposed to be a feature of the vulnerable atheroslerotic plaque. However, till now little is known regarding the clinical impact of expansive remodeling of carotid lesions. Therefore, we sought to evaluate the correlation of expansive arterial remodeling of the carotid arteries with atherosclerotic plaque composition and vulnerability using in-vivo Cardiovascular Magnetic Resonance (CMR).MethodsOne hundred eleven symptomatic patients (74 male/71.8 ± 10.3y) with acute unilateral ischemic stroke and carotid plaques of at least 2 mm thickness were included. All patients received a dedicated multi-sequence black-blood carotid CMR (3Tesla) of the proximal internal carotid arteries (ICA). Measurements of lumen, wall, outer wall, hemorrhage, calcification and necrotic core were determined. Each vessel-segment was classified according to American Heart Association (AHA) criteria for vulnerable plaque. A modified remodeling index (mRI) was established by dividing the average outer vessel area of the ICA segments by the lumen area measured on TOF images in a not affected reference segment at the distal ipsilateral ICA. Correlations of mRI and clinical symptoms as well as plaque morphology/vessel dimensions were evaluated.ResultsSeventy-eight percent (157/202) of all internal carotid arteries showed atherosclerotic disease with AHA Lesion-Type (LT) III or higher. The mRI of the ICA was significantly different in normal artery segments (AHA LT I; mRI 1.9) compared to atherosclerotic segments (AHA LT III-VII; mRI 2.5; p < 0.0001). Between AHA LT III-VII there was no significant difference of mRI. Significant correlations (p < 0.05) of the mRI with lumen-area (LA), wall-area (WA), vessel-area (VA) and wall-thickness (WT), necrotic-core area (NC), and ulcer-area were observed. With respect to clinical presentation (symptomatic/asymptomatic side) and luminal narrowing (stenotic/non-stenotic) no relevant correlations or significant differences regarding the mRI were found.ConclusionExpansive arterial remodeling exists in the ICA. However, no significant association between expansive arterial remodeling, stroke symptoms, complicated AHA VI plaque, and luminal stenosis could be established. Hence, results of our study suggest that expansive arterial remodeling is not a very practical marker for plaque vulnerability in the carotid arteries.
Highlights
Based on intravascular ultrasound of the coronary arteries expansive arterial remodeling is supposed to be a feature of the vulnerable atheroslerotic plaque
Results of our study suggest that expansive arterial remodeling is not a very practical marker for plaque vulnerability in the carotid arteries
American Heart Association (AHA)-LT III was detected in 75 % (86/111) of all patients, AHA-LT IV/V and VII had a prevalence of 46 % (51/111) and 41 % (45/111), respectively
Summary
Based on intravascular ultrasound of the coronary arteries expansive arterial remodeling is supposed to be a feature of the vulnerable atheroslerotic plaque. In contrast to the endovascular ultrasound-based studies of the coronary arteries, most of the studies on carotid arteries in the past were based either on in-vitro animal models or on autopsy specimen [6,7,8,9] These studies do not provide sufficient information about remodeling patterns. Only relatively few and small studies evaluated arterial remodeling of the carotid arteries in-vivo and until now little is known regarding the clinical significance of remodeling in this particular vascular bed Since it has been shown in various studies that black-blood CMR is capable of precisely evaluating plaque-burden and vessel-diameters [10,11,12], in this study we sought to evaluate the association between expansive carotid remodeling and ischemic stroke as well as plaque features (AHA-lesion-type, luminal stenosis) using in-vivo blackblood CMR
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