Magnetic resonance imaging plaque hemorrhage for risk stratification in carotid artery disease with moderate risk under current medical therapy
Background and Purpose—Magnetic resonance imaging (MRI)–defined carotid plaque hemorrhage (MRIPH) can predict recurrent cerebrovascular ischemic events in severe symptomatic carotid stenosis. It is less clear whether MRIPH can improve risk stratification despite optimized medical secondary preventio...
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| Format: | Article |
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American Heart Association
2017
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| Online Access: | https://eprints.nottingham.ac.uk/50344/ |
| _version_ | 1848798227365625856 |
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| author | Hosseini, Akram A. Simpson, Richard J. Altaf, Nishath Bath, Philip M.W. MacSweeney, Shane T. Auer, Dorothee P. |
| author_facet | Hosseini, Akram A. Simpson, Richard J. Altaf, Nishath Bath, Philip M.W. MacSweeney, Shane T. Auer, Dorothee P. |
| author_sort | Hosseini, Akram A. |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Background and Purpose—Magnetic resonance imaging (MRI)–defined carotid plaque hemorrhage (MRIPH) can predict recurrent cerebrovascular ischemic events in severe symptomatic carotid stenosis. It is less clear whether MRIPH can improve risk stratification despite optimized medical secondary prevention in those with moderate risk.
Methods—One-hundred fifty-one symptomatic patients with 30% to 99% carotid artery stenosis (median age: 77, 60.5% men) clinically deemed to not benefit from endarterectomy were prospectively recruited to undergo MRI and clinical follow-up (mean, 22 months). The clinical carotid artery risk score could be evaluated in 88 patients. MRIPH+ve was defined as plaque intensity >150% that of adjacent muscle. Survival analyses were performed with recurrent infarction (stroke or diffusion-positive cerebral ischemia) as the main end point.
Results—Fifty-five participants showed MRIPH+ve; 47 had low, 36 intermediate, and 5 high carotid artery risk scores. Cox regression showed MRIPH as a strong predictor of future infarction (hazard ratio, 5.2; 95% confidence interval, 1.64–16.34; P=0.005, corrected for degree of stenosis), also in the subgroup with 50% to 69% stenosis (hazard ratio, 4.1; 95% confidence interval, 1–16.8; P=0.049). The absolute risk of future infarction was 31.7% at 3 years in MRIPH+ve versus 1.8% in patients without (P<0.002). MRIPH increased cumulative risk difference of future infarction by 47.1% at 3 years in those with intermediate carotid artery risk score (P=0.004).
Conclusions—The study confirms MRIPH to be a powerful risk marker in symptomatic carotid stenosis with added value over current risk scores. For patients undergoing current secondary prevention medication with clinically uncertain benefit from recanalization, that is, those with moderate degree stenosis and intermediate carotid artery risk scores, MRIPH offers additional risk stratification. |
| first_indexed | 2025-11-14T20:16:25Z |
| format | Article |
| id | nottingham-50344 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T20:16:25Z |
| publishDate | 2017 |
| publisher | American Heart Association |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-503442024-08-15T15:22:03Z https://eprints.nottingham.ac.uk/50344/ Magnetic resonance imaging plaque hemorrhage for risk stratification in carotid artery disease with moderate risk under current medical therapy Hosseini, Akram A. Simpson, Richard J. Altaf, Nishath Bath, Philip M.W. MacSweeney, Shane T. Auer, Dorothee P. Background and Purpose—Magnetic resonance imaging (MRI)–defined carotid plaque hemorrhage (MRIPH) can predict recurrent cerebrovascular ischemic events in severe symptomatic carotid stenosis. It is less clear whether MRIPH can improve risk stratification despite optimized medical secondary prevention in those with moderate risk. Methods—One-hundred fifty-one symptomatic patients with 30% to 99% carotid artery stenosis (median age: 77, 60.5% men) clinically deemed to not benefit from endarterectomy were prospectively recruited to undergo MRI and clinical follow-up (mean, 22 months). The clinical carotid artery risk score could be evaluated in 88 patients. MRIPH+ve was defined as plaque intensity >150% that of adjacent muscle. Survival analyses were performed with recurrent infarction (stroke or diffusion-positive cerebral ischemia) as the main end point. Results—Fifty-five participants showed MRIPH+ve; 47 had low, 36 intermediate, and 5 high carotid artery risk scores. Cox regression showed MRIPH as a strong predictor of future infarction (hazard ratio, 5.2; 95% confidence interval, 1.64–16.34; P=0.005, corrected for degree of stenosis), also in the subgroup with 50% to 69% stenosis (hazard ratio, 4.1; 95% confidence interval, 1–16.8; P=0.049). The absolute risk of future infarction was 31.7% at 3 years in MRIPH+ve versus 1.8% in patients without (P<0.002). MRIPH increased cumulative risk difference of future infarction by 47.1% at 3 years in those with intermediate carotid artery risk score (P=0.004). Conclusions—The study confirms MRIPH to be a powerful risk marker in symptomatic carotid stenosis with added value over current risk scores. For patients undergoing current secondary prevention medication with clinically uncertain benefit from recanalization, that is, those with moderate degree stenosis and intermediate carotid artery risk scores, MRIPH offers additional risk stratification. American Heart Association 2017-02-14 Article PeerReviewed Hosseini, Akram A., Simpson, Richard J., Altaf, Nishath, Bath, Philip M.W., MacSweeney, Shane T. and Auer, Dorothee P. (2017) Magnetic resonance imaging plaque hemorrhage for risk stratification in carotid artery disease with moderate risk under current medical therapy. Stroke, 48 (3). pp. 678-685. ISSN 1524-4628 atherosclerotic plaque; carotid stenosis; cerebral infarction; endarterectomy; magnetic resonance imaging; stroke http://stroke.ahajournals.org/content/48/3/678 doi:10.1161/STROKEAHA.116.015504 doi:10.1161/STROKEAHA.116.015504 |
| spellingShingle | atherosclerotic plaque; carotid stenosis; cerebral infarction; endarterectomy; magnetic resonance imaging; stroke Hosseini, Akram A. Simpson, Richard J. Altaf, Nishath Bath, Philip M.W. MacSweeney, Shane T. Auer, Dorothee P. Magnetic resonance imaging plaque hemorrhage for risk stratification in carotid artery disease with moderate risk under current medical therapy |
| title | Magnetic resonance imaging plaque hemorrhage for risk stratification in carotid artery disease with moderate risk under current medical therapy |
| title_full | Magnetic resonance imaging plaque hemorrhage for risk stratification in carotid artery disease with moderate risk under current medical therapy |
| title_fullStr | Magnetic resonance imaging plaque hemorrhage for risk stratification in carotid artery disease with moderate risk under current medical therapy |
| title_full_unstemmed | Magnetic resonance imaging plaque hemorrhage for risk stratification in carotid artery disease with moderate risk under current medical therapy |
| title_short | Magnetic resonance imaging plaque hemorrhage for risk stratification in carotid artery disease with moderate risk under current medical therapy |
| title_sort | magnetic resonance imaging plaque hemorrhage for risk stratification in carotid artery disease with moderate risk under current medical therapy |
| topic | atherosclerotic plaque; carotid stenosis; cerebral infarction; endarterectomy; magnetic resonance imaging; stroke |
| url | https://eprints.nottingham.ac.uk/50344/ https://eprints.nottingham.ac.uk/50344/ https://eprints.nottingham.ac.uk/50344/ |