Circulation. 2002;105:181-185
doi: 10.1161/hc0202.102121
doi: 10.1161/hc0202.102121
(Circulation. 2002;105:181.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Identification of Fibrous Cap Rupture With Magnetic Resonance Imaging Is Highly Associated With Recent Transient Ischemic Attack or Stroke
From the Departments of Radiology (C.Y., S.Z., D.E., G.O., J.W.D., M.S.F) and Medicine (E.E.), University of Washington, Seattle; Mountain-Whisper-Light Statistical Consulting (N.L.P.), Seattle; and Surgery and Perioperative Care, VA Puget Sound Health Care System (T.S.H.), Seattle, Wash.
Correspondence to Chun Yuan, PhD, University of Washington, Department of Radiology, Box 357115, 1959 NE Pacific Ave, Seattle, WA 98195. E-mail cyuan{at}u.washington.edu
Background— High-resolution MRI has been shown to be capable of distinguishing intact, thick fibrous caps from thin and ruptured caps in human carotid atherosclerosis in vivo. The aim of this study was to determine whether MRI identification of fibrous cap thinning or rupture is associated with a history of recent transient ischemic attack (TIA) or stroke.
Methods and Results— Fifty-three consecutive patients (mean age, 71 years; 49 male) scheduled for carotid endarterectomy were recruited after obtaining informed consent. Twenty-eight subjects had a recent history of TIA or stroke on the side appropriate to the index carotid lesion, and 25 were asymptomatic. Preoperative carotid MRI was performed in a 1.5-T GE Signa scanner that generated T1-, PD-, and T2-weighted and three-dimensional time-of-flight images. Using previously reported MRI criteria, the fibrous cap was categorized as intact-thick, intact-thin, or ruptured for each carotid plaque by blinded review. There was a strong and statistically significant trend showing a higher percentage of symptomatic patients for ruptured caps (70%) compared with thick caps (9%) (P=0.001 Mann-Whitney test for cap status versus symptoms). Compared with patients with thick fibrous caps, patients with ruptured caps were 23 times more likely to have had a recent TIA or stroke (95% CI=3, 210).
Conclusions— MRI identification of a ruptured fibrous cap is highly associated with a recent history of TIA or stroke. Ongoing prospective studies will determine the predictive value fibrous cap characteristics, as visualized by MRI, for risk of subsequent ischemic events.
Key Words: magnetic resonance imaging • atherosclerosis • carotid arteries • stroke
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