Abstract
Correct stratification of ischemic stroke risk allows for the proper treatment of carotid atherosclerotic disease. We seek to differentiate plaque types based on stenosis level and plaque morphology. The Chinese Atherosclerosis Risk Evaluation (CARE–II) study is a cross-sectional, observational, multicenter study to assess carotid atherosclerotic plaques in symptomatic subjects using vessel wall magnetic resonance imaging. Plaque morphology and presence of plaque components were reviewed using multi-contrast magnetic resonance imaging. The carotid arteries were divided into four groups based on stenosis level and plaque components. Out of 1072 ischemic stroke subjects, 452 ipsilateral side carotid arteries were included. Significant stenosis (SS) (≥50% stenosis) with high-risk plaque (HRP) features was present in 37 arteries (8.2%), SS(+)/HRP(−) in 29 arteries (6.4%), SS(−)/HRP(+) in 57 arteries (12.6%), and SS(−)/HRP(−) in 329 arteries (72.8%). The prevalence of SS(−)/HRP(+) arteries in this cohort was substantial and had greater wall thickness than the SS(+)/HRP(−) group. These arteries may be misclassified for carotid revascularization by current guidelines based on the degree of luminal stenosis only. These findings have implications for further studies to assess stroke risk using vessel wall imaging.
Highlights
15–20% of ischemic strokes derive from carotid atherosclerotic plaques [1]
The current study examines the relationships between plaque morphology, stenosis levels, and location of plaques in the ipsilateral side of carotid arteries to identify groups whose risk may be miscategorized by current guidelines [2,3,4,5]
No significant difference was found, males tended to have high-risk plaque (HRP) compared to females in both significant and non-significant stenosis groups
Summary
15–20% of ischemic strokes derive from carotid atherosclerotic plaques [1].Currently, the most widely used estimator of ischemic stroke risk in both symptomatic and asymptomatic patients is the degree of carotid stenosis [2,3,4,5]. Rupture of atherosclerotic plaque in the carotid artery is believed to be the main source of ischemic embolic cerebrovascular events, including stroke and transient ischemic attacks [6]. This has led to many ground-breaking studies that link plaque rupture to compositional features. The ability of magnetic resonance imaging (MRI) to characterize plaque components is well established and multiple MRI based prospective studies have identified the plaque features linked to the development of future clinical events.
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