Abstract
PurposeTo investigate the natural history of carotid atherosclerosis in patients who experienced a TIA or ischemic stroke.Patients and MethodsNinety-two TIA/stroke patients (57 men, mean age 67.7±9.8 years) with ipsilateral <70% carotid stenosis underwent multisequence MRI of the plaque ipsilateral to the symptomatic side at baseline and after one year. For each plaque, several parameters were assessed at both time points.ResultsCarotid lumen, wall and total vessel ( = carotid lumen and wall) volume did not significantly change. Forty-four patients had a plaque with a lipid-rich necrotic core (LRNC) at baseline, of which 34 also had a LRNC after one year. In three patients a LRNC appeared after one year. Thirty patients had a plaque with a thin and/or ruptured fibrous cap (FC) at both time points. In seven patients, FC status changed from thin and/or ruptured into thick and intact. In three patients, FC status changed from thick and intact into thin and/or ruptured. Twenty patients had intraplaque hemorrhage (IPH) at both time points. In four patients, IPH disappeared, whereas in three patients, new IPH appeared at follow-up.ConclusionIn TIA/stroke patients, carotid plaque morphology does not significantly change over a one-year period. IPH and FC status change in a minority of patients.
Highlights
Carotid atherosclerosis is an important cause of ischemic stroke
Carotid endarterectomy has shown to be beneficial in symptomatic patients with .70% stenosis [3]
The results of the present study show that plaque morphology in TIA/stroke patients with 30–69% carotid stenosis does not significantly change over a one-year period
Summary
Carotid atherosclerosis is an important cause of ischemic stroke. Carotid endarterectomy has shown to be beneficial in symptomatic patients (i.e. those who experienced a TIA or ischemic stroke) with .70% stenosis [3]. In patients with 30–69% stenosis, the benefit is less clear [3]. Little has been published on the natural history of carotid plaques in symptomatic patients [4]. Knowledge on the natural history may help improving understanding of atherosclerosis and may enable management of modifiable risk factors. The purpose of the present study was to investigate the natural course of carotid plaques in symptomatic patients, using MRI. Results of the first 40 patients have been reported previously in a pilot study [4]. The present study was expanded with another 52 patients
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