Abstract
Although carotid artery intraplaque hemorrhage (IPH) is a known risk-factor for cerebral ischemic events in patients of advanced age, its prevalence in younger cohorts is less certain. The purpose of this study was to assess the prevalence of carotid artery IPH across the age spectrum. A retrospective review was completed of all adult patients from our institution who underwent neck MRA with high-resolution carotid plaque imaging between 2017 and 2020. The mean ages of patients with and without IPH were calculated. The prevalence of IPH was compared between patients that were categorized into age groups. Patients with and without a cerebral ischemic event (e.g., stroke, retinal ischemia) were included. Unilateral anterior circulation ischemic events in patients without atrial fibrillation were presumed to be likely related to ipsilateral carotid artery disease. Multiple regression analysis was performed to determine independent associations with IPH. 634 patients were included (1,268 carotid arteries). Increasing age (OR: 1.04; 95% CI: 1.02–1.06; P = 0.001) was independently associated with IPH. 211 patients had unilateral anterior circulation ischemic events. The mean age of patients with carotid IPH was 71.4 years (SD = 9.9), compared to 62.8 years (SD = 15.8) of those without (P ≤ 0.0001). The prevalence of IPH increased with age in all patients (P = 0.0002). Among patients with ipsilateral anterior circulation ischemic events, each age category above 50 years had a significantly higher prevalence of IPH when compared to patients 18–50 years (P ≤ 0.05 for all comparisons). The prevalence of carotid IPH increases with age and is rare in patients under 50 years. The approximate threshold age for IPH development is likely around 50 years.
Highlights
Carotid artery atherosclerosis is a well-known risk factor for ischemic stroke [1]
Relevant variables extracted from each record included patient age at MRA imaging, vascular comorbidities and whether or not the patient had a documented history of a cerebral ischemic event defined as ischemic stroke, transient ischemic attack (TIA), retinal artery occlusion (RAO), or amaurosis fugax
The results from this study indicate that MRA evidence of carotid intraplaque hemorrhage (IPH) is independently-associated with increasing age
Summary
Carotid artery atherosclerosis is a well-known risk factor for ischemic stroke [1]. With advances in carotid plaque imaging, various plaque characteristics such as intraplaque hemorrhage (IPH), lipid rich necrotic core and inflammation have become increasingly recognized as features of plaque vulnerability [2]. The majority of studies regarding IPH involve cohorts of patients of advanced age Almost certainly, this is because the risk of both stroke and carotid artery atherosclerosis substantially increases with age [6,7,8]. This is because the risk of both stroke and carotid artery atherosclerosis substantially increases with age [6,7,8] It remains uncertain if a threshold age exists at which the prevalence of IPH becomes more prominent. Such information may aid in determining which age groups may be at higher risk for IPH, and would benefit from dedicated carotid plaque imaging. The objectives of the current study were to [1] Identify the prevalence of IPH across the age spectrum in a large cohort of patients, and [2] Determine at which age the prevalence of IPH becomes more prominent
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