Intraplaque hemorrhage, fibrous cap status, and microembolic signals in symptomatic patients with mild to moderate carotid artery stenosis: the Plaque at RISK study

Martine T B Truijman; Alexandra A J de Rotte; Rune Aaslid; Anouk C van Dijk; Jeire Steinbuch; Madieke I Liem; Floris H B M Schreuder; Anton F W van der Steen; Mat J A P Daemen; Robert J van Oostenbrugge; Joachim E Wildberger; Paul J Nederkoorn; Jeroen Hendrikse; Aad van der Lugt; Marianne Eline Kooi; Werner H Mess; Plaque at RISK Study

doi:10.1161/STROKEAHA.114.006800

Intraplaque hemorrhage, fibrous cap status, and microembolic signals in symptomatic patients with mild to moderate carotid artery stenosis: the Plaque at RISK study

Stroke. 2014 Nov;45(11):3423-6. doi: 10.1161/STROKEAHA.114.006800. Epub 2014 Sep 25.

Authors

Martine T B Truijman¹, Alexandra A J de Rotte¹, Rune Aaslid¹, Anouk C van Dijk¹, Jeire Steinbuch¹, Madieke I Liem¹, Floris H B M Schreuder¹, Anton F W van der Steen¹, Mat J A P Daemen¹, Robert J van Oostenbrugge¹, Joachim E Wildberger¹, Paul J Nederkoorn¹, Jeroen Hendrikse¹, Aad van der Lugt¹, Marianne Eline Kooi¹, Werner H Mess²; Plaque at RISK Study

Collaborators

Plaque at RISK Study:
P J Nederkoorn, A H C M L Schreuder, A van der Lugt, P J Koudstaal, M Limburg, M Weisfelt, A G Korten, R Saxena, M E Kooi, R J van Oostenbrugge, W H Mess, N P van Orshoven, S C Tromp, N D Kruyt, J R de Kruijk, J Hendrikse, G J de Borst, B J Meems, J C B Verhey, A D Wijnhoud

Affiliations

¹ From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands.
² From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands. werner.mess@mumc.nl.

PMID: 25256179
DOI: 10.1161/STROKEAHA.114.006800

Abstract

Background and purpose: In patients with mild to moderate symptomatic carotid artery stenosis, intraplaque hemorrhage (IPH) and a thin/ruptured fibrous cap (FC) as evaluated with MRI, and the presence of microembolic signals (MESs) as detected with transcranial Doppler, are associated with an increased risk of a (recurrent) stroke. The objective of the present study is to determine whether the prevalence of MES differs in patients with and without IPH and thin/ruptured FC, and patients with only a thin/ruptured FC without IPH.

Methods: In this multicenter, diagnostic cohort study, patients with recent transient ischemic attack or minor stroke in the carotid territory and an ipsilateral mild to moderate carotid artery plaque were included. IPH and FC status were dichotomously scored. Analysis of transcranial Doppler data was done blinded for the MRI results. Differences between groups were analyzed with Fisher exact test.

Results: A total of 113 patients were included. Transcranial Doppler measurements were feasible in 105 patients (average recording time, 219 minutes). A total of 26 MESs were detected in 8 of 105 patients. In 44 of 105 plaques IPH was present. In 92 of 105 plaques FC status was assessable, 36 of these had a thin/ruptured FC. No significant difference in the prevalence of MES between patients with and without IPH (P=0.46) or with thick versus thin/ruptured FC (P=0.48) was found.

Conclusions: In patients with a symptomatic mild to moderate carotid artery stenosis, IPH and FC status are not associated with MES. This suggests that MRI and transcranial Doppler provide different information on plaque vulnerability.

Clinical trial registration url: http://www.clinicaltrials.gov. Unique identifier: NCT01709045.

Keywords: magnetic resonance imaging; plaque, atherosclerotic; transcranial Doppler sonography.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Carotid Stenosis / diagnosis*
Carotid Stenosis / epidemiology
Cerebral Hemorrhage / diagnosis*
Cerebral Hemorrhage / epidemiology
Cohort Studies
Female
Humans
Intracranial Embolism / diagnosis*
Intracranial Embolism / epidemiology
Male
Microcirculation* / physiology
Middle Aged
Plaque, Atherosclerotic / diagnosis*
Plaque, Atherosclerotic / epidemiology
Single-Blind Method

Associated data

ClinicalTrials.gov/NCT01709045