In Reply:

Abstract

We would like to express our gratitude to the authors for their thoughtful comments about our article.1 In our study, we indicated that patients with intraplaque hemorrhage, as detected by hyperintense plaque on black-blood T1-weighted imaging regardless of degree of stenosis, have a higher risk of subsequent ipsilateral ischemic events. However, the reason we did not include anything regarding the risk of recurrence for all patients with intraplaque hemorrhage, compared with those without T1-weighted hyperintense plaques, was that our study lacked the necessary data concerning the mild to moderate stenosis group without intraplaque hemorrhage. The recurrence event rates were 16.7% in the black-blood T1-weighted imaging–positive group and 3% in the negative group with severe stenosis. A Kaplan-Meier analysis showed a trend toward a lower event-free survival rate in the black-blood T1-weighted imaging–positive group (log-rank test = 2.94, P = .09), but there was no significant difference in the recurrence event rates. The small number of patients may account for the lack of a statistically significant difference. We are in complete agreement with the authors that further studies of asymptomatic patients with moderate stenosis are necessary. As we mentioned in our Discussion, our study was a retrospective evaluation and targeted symptomatic patients who probably already had fibrous cap rupture, one of the most important risk factors in cerebral ischemic events.2 We are in the process of undertaking research on asymptomatic patients with moderate stenosis. Yoshitaka Kurosaki Osaka, Japan Kazumichi Yoshida Sen Yamagata Okayama, Japan