Abstract 19699: Comparison Between Symptomatic and Asymptomatic Carotid Plaques in Patients With Bilateral Intraplaque Hemorrhage
Introduction: Prospective studies have showed a strong association between intraplaque hemorrhage (IPH) on carotid MRI and increased risk of cerebrovascular ischemic events. However, it is also seen in a substantial number of asymptomatic patients. Serial MRI studies indicate that IPH can persist for years before causing clinical symptoms.
Hypothesis: We hypothesized that there are differences in the characteristics of IPH-positive (IPH+) plaques associated with recent symptoms, compared to IPH+ plaques not associated with recent symptoms.
Methods: Patients with recent (≤2 weeks) cerebrovascular ischemic events were scanned with a standardized multicontrast protocol that included time-of-flight, black-blood fast spin echoes, and magnetization prepared rapid acquisition gradient echo (MPRAGE). Those showing IPH bilaterally on MPRAGE were included. Multicontrast images were reviewed to obtain information of bilateral IPH+ plaques on plaque morphology and coexisting plaque characteristics. Quantitative measurements on IPH signals were performed on MPRAGE, including signal-intensity-ratio (SIR) as compared to adjacent muscle, longitudinal length, cross-sectional area, and total volume.
Results: Thirty-one subjects (67±9 years, 97% males) were identified to have bilateral IPH. The symptomatic and asymptomatic side showed similar luminal stenosis (53±42% vs. 53±39%, p=0.99). MR signals of IPH were stronger (SIR: 5.8±2.4 vs. 4.7±1.8, p=0.004) and tended to be more extensively distributed (IPH volume: 150±199 mm3 vs. 88±106 mm3, p=0.071) on the symptomatic side. IPH+ plaques on the symptomatic side were longer (24±6 mm vs. 21±7 mm, p=0.026) and had larger necrotic core volume (406±354 mm3 vs. 291±293 mm3, p=0.039) than those on the asymptomatic side. The focal plaque burden (maximum % wall area: 77±12% vs. 73±11%, p=0.071) and prevalence of mural thrombus (29% vs. 10%, p=0.11) also tended to be higher on the symptomatic side. Calcification volume (54±51 mm3 vs. 55±95 mm3, p=0.90) and prevalence of surface ulceration (42% vs. 32%, p=0.55) were similar.
Conclusions: In patients with bilateral carotid IPH, IPH on the symptomatic side showed stronger MR signals, which may indicate more accumulative IPH, than those on the asymptomatic side.
Author Disclosures: X. Wang: None. J. Sun: None. X. Zhao: None. D.S. Hippe: None. J. Liu: None. T.S. Hatsukami: None. R. Li: None. G. Canton: None. Y. Song: None. C. Yuan: None.
- © 2016 by American Heart Association, Inc.