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Carotid plaque hemorrhage

Mat J Daemen, Marina S Ferguson, Frank J Gijsen, Daniel S Hippe, M Eline Kooi, Kevin Demarco, Allard C van der Wal, Chun Yuan, Thomas S Hatsukami
BACKGROUND AND AIMS: Plaque fissuring, a phenomenon morphologically distinct from the classical rupture of a thinned fibrous cap, has not been well characterized in carotid atherosclerosis. The aim of this study was to establish the prevalence of plaque fissures in advanced carotid plaques with an otherwise intact luminal surface, and to determine whether they might be a source of intraplaque hemorrhage (IPH). METHODS: We evaluated 244 surgically intact, 'en bloc' embedded, serially sectioned carotid endarterectomy specimens and included only those plaques with a grossly intact luminal surface...
September 28, 2016: Atherosclerosis
Dandan Wang, Jing Wang, Cheng Jin, Ruijun Ji, Anxin Wang, Xin Li, Xiang Gao, Shouling Wu, Yong Zhou, Xingquan Zhao
Asymptomatic extracranial artery stenosis (ECAS) is a well-known risk factor for stroke events, but it remains unclear whether it has the same role in predicting cardiovascular and cerebrovascular diseases, especially in China. We investigated the potential associations between ECAS, carotid plaque and carotid intima-media thickness and the new occurrence of cardiovascular and cerebrovascular diseases in the study. Out of 5440 study participants, 364 showed an asymptomatic ECAS at baseline, and 185 had come up to the final vascular events (brain infarction, intracerebral hemorrhage, subarachnoid hemorrhage, coronary heart disease and death due to the vascular diseases)...
2016: Scientific Reports
Jaroslav Pelisek, Heiko Wendorff, Carina Wendorff, Andreas Kuehnl, Hans-Henning Eckstein
Little is known about changes in carotid plaque morphology during aging and the possible impact on cardiovascular events. Only few studies addressed so far age-related modifications within atherosclerotic lesions. Therefore, in this work we endeavored to summarize the current knowledge about changing of plaque composition in elderly. The data from hitherto existing studies confirm that atherosclerotic plaques undergo distinct alternations with advanced age. However, the results are often ambiguous and the changes do not seem to be as disastrous as expected...
September 5, 2016: Annals of Medicine
Yuanyuan Dai, Peng Lv, Jiang Lin, Rongkui Luo, Hao Liu, Aihua Ji, Hui Liu, Caixia Fu
PURPOSE: To compare Multicontrast ATherosclerosis Characterization (MATCH) with conventional multicontrast magnetic resonance imaging (MRI) in the characterization and quantification of carotid plaque components. MATERIALS AND METHODS: Fifty-three consecutive patients underwent carotid plaque 3.0T MRI including conventional multicontrast sequences and MATCH, with 13 of them having carotid endarterectomy for histology validation. The detection of major plaque components including lipid-rich necrotic core (LRNC), loose matrix (LM), intraplaque hemorrhage (IPH), and calcification (CA) and measurement of lumen area, outer wall area, normalized wall index (NWI), and plaque components areas were compared between the two protocols...
August 24, 2016: Journal of Magnetic Resonance Imaging: JMRI
Johan W Verjans, Eric A Osborn, Giovanni J Ughi, Marcella A Calfon Press, Ehsan Hamidi, Antonios P Antoniadis, Michail I Papafaklis, Mark F Conrad, Peter Libby, Peter H Stone, Richard P Cambria, Guillermo J Tearney, Farouc A Jaffer
OBJECTIVES: This study sought to determine whether indocyanine green (ICG)-enhanced near-infrared fluorescence (NIRF) imaging can illuminate high-risk histologic plaque features of human carotid atherosclerosis, and in coronary atheroma of living swine, using intravascular NIRF-optical coherence tomography (OCT) imaging. BACKGROUND: New translatable imaging approaches are needed to identify high-risk biological signatures of atheroma. ICG is a U.S. Food and Drug Administration-approved NIRF imaging agent that experimentally targets plaque macrophages and lipid in areas of enhanced endothelial permeability...
September 2016: JACC. Cardiovascular Imaging
J David Spence
In recent years, there have been a number of advances in the pathogenesis and treatment of atherosclerosis and in assessing prognosis in carotid atherosclerosis. Risk stratification to improve vascular prevention by identifying patients most likely to benefit from intensive therapy is much improved by measuring carotid plaque burden. In patients with asymptomatic carotid stenosis, a number of modalities can be used to identify the 10-15% who could benefit from endarterectomy or stenting. Transcranial Doppler embolus detection, echolucency and ulceration on 3D ultrasound, intraplaque hemorrhage on magnetic resonance imaging (MRI), and reduced cerebrovascular reserve are useful already; new approaches including plaque texture on ultrasound and imaging of plaque inflammation and early calcification on positron emission tomography/computed tomography (PET/CT) are in development...
2016: F1000Research
Sandeep Koppal, Marcel Warntjes, Jeremy Swann, Petter Dyverfeldt, Johan Kihlberg, Rodrigo Moreno, Derek Magee, Nicholas Roberts, Helene Zachrisson, Claes Forssell, Toste Länne, Darren Treanor, Ebo D de Muinck
PURPOSE: The aim of this work was to quantify the extent of lipid-rich necrotic core (LRNC) and intraplaque hemorrhage (IPH) in atherosclerotic plaques. METHODS: Patients scheduled for carotid endarterectomy underwent four-point Dixon and T1-weighted magnetic resonance imaging (MRI) at 3 Tesla. Fat and R2* maps were generated from the Dixon sequence at the acquired spatial resolution of 0.60 × 0.60 × 0.70 mm voxel size. MRI and three-dimensional (3D) histology volumes of plaques were registered...
August 11, 2016: Magnetic Resonance in Medicine: Official Journal of the Society of Magnetic Resonance in Medicine
Monica de Gaetano, Daniel Crean, Mary Barry, Orina Belton
Atherosclerosis is an inflammatory disease caused by endothelial injury, lipid deposition, and oxidative stress. This progressive disease can be converted into an acute clinical event by plaque rupture and thrombosis. In the context of atherosclerosis, the underlying cause of myocardial infarction and stroke, macrophages uniquely possess a dual functionality, regulating lipid accumulation and metabolism and sustaining the chronic inflammatory response, two of the most well-documented pathways associated with the pathogenesis of the disease...
2016: Frontiers in Immunology
Q Q Deng, J Tang, C Chen, H Markus, Y N Huang, H Zhao, D Ratanakorn, K S L Wong, J H Fu
BACKGROUND: Microembolic signals (MESs) are direct markers of unstable large artery atherosclerotic plaques. In a previous study, we found that the number of MESs is associated with stroke recurrence and that clopidogrel plus aspirin more effectively reduce the number of MESs than does aspirin alone. Stroke recurrence is associated with not only the number of MESs but also the size of the MES, which can theoretically be estimated by monitoring the MES intensity via transcranial doppler (TCD)...
August 15, 2016: Journal of the Neurological Sciences
Seong-Eun Kim, John A Roberts, Laura B Eisenmenger, Booth W Aldred, Osama Jamil, Bradley D Bolster, Xiaoming Bi, Dennis L Parker, Gerald S Treiman, J Scott McNally
PURPOSE: Carotid artery imaging is important in the clinical management of patients at risk for stroke. Carotid intraplaque hemorrhage (IPH) presents an important diagnostic challenge. 3D magnetization prepared rapid acquisition gradient echo (MPRAGE) has been shown to accurately image carotid IPH; however, this sequence can be limited due to motion- and flow-related artifact. The purpose of this work was to develop and evaluate an improved 3D carotid MPRAGE sequence for IPH detection...
July 7, 2016: Journal of Magnetic Resonance Imaging: JMRI
Atsushi Ogata, Masatou Kawashima, Tomihiro Wakamiya, Masashi Nishihara, Jun Masuoka, Yukiko Nakahara, Ryo Ebashi, Kohei Inoue, Yukinori Takase, Hiroyuki Irie, Tatsuya Abe
OBJECTIVE Hypoxia induces angiogenesis and plays a major role in the progression of carotid plaques. During carotid intervention, plaques with high-intensity signals on time-of-flight (TOF) magnetic resonance angiography (MRA) often cause ischemic stroke and embolic complications. However, the role of intraplaque hypoxia before carotid endarterectomy (CEA) and carotid artery stenting is not presently understood. In this study the authors aimed to investigate the relationship between intraplaque hypoxia and MRA findings...
July 1, 2016: Journal of Neurosurgery
Adrian Brun, Hélène Rangé, Bastien Prouvost, Olivier Meilhac, Mikael Mazighi, Pierre Amarenco, Guy Lesèche, Philippe Bouchard, Jean-Baptiste Michel
Periodontal diseases are multifactorial inflammatory diseases, caused by a bacterial biofilm involving both innate and adaptative immunity, characterized by the destruction of tooth-supporting tissues. In the context of periodontitis, the spread of weak pathogenic bacteria into the bloodstream has been described. These bacteria will preferentially localize to existing clot within the circulation. Atherothrombosis of the carotid arteries is a local pathology and a common cause of cerebral infarction. Intraplaque hemorrhages render the lesion more prone to clinical complications such as stroke...
2016: Bulletin du Groupèment International Pour la Recherche Scientifique en Stomatologie & Odontologie
Makoto Sasaki
Magnetic resonance plaque imaging is widely used to characterize atherosclerotic plaques of the cervical carotid artery to prevent future stroke events and surgical complications. Intraplaque contrast considerably varies among the T1-weighted MRI techniques, which should be optimized. Non-gated 2-dimensional spin-echo or 3-dimensional fast spin-echo techniques with appropriate scanning parameters can readily characterize vulnerable intraplaque components including lipid, necrosis, and hemorrhage.
April 2016: Nihon Rinsho. Japanese Journal of Clinical Medicine
J S McNally, T M Burton, B W Aldred, S-E Kim, M S McLaughlin, L B Eisenmenger, G J Stoddard, J J Majersik, D V Miller, G S Treiman, D L Parker
BACKGROUND AND PURPOSE: MR imaging-detected carotid intraplaque hemorrhage indicates vulnerable plaque with high stroke risk. Angiotensin II stimulates intraplaque hemorrhage in animal models, and the angiotensin system is highly regulated by vitamin D. Our purpose was to determine whether low vitamin D levels predict carotid intraplaque hemorrhage in humans. MATERIALS AND METHODS: In this cross-sectional study, 65 patients with carotid disease underwent carotid MR imaging and blood draw...
June 16, 2016: AJNR. American Journal of Neuroradiology
Benoy N Shah, Dorothy M Gujral, Navtej S Chahal, Kevin J Harrington, Christopher M Nutting, Roxy Senior
OBJECTIVES: The aim of this study was to determine the effect of radiotherapy (RT) on intraplaque neovascularization (IPN) in human carotid arteries. BACKGROUND: Exposure of the carotid arteries to RT during treatment for head and neck cancer is associated with increased risk for stroke. However, the effect of RT on IPN, a precursor to intraplaque hemorrhage and thus associated with plaque vulnerability, is unknown. METHODS: In this cross-sectional study, patients who had undergone unilateral RT for head and neck cancer ≥2 years previously underwent B-mode and contrast-enhanced ultrasound of both RT-side and non-RT-side carotid arteries...
June 2016: JACC. Cardiovascular Imaging
Mariana Selwaness, Daniel Bos, Quirijn van den Bouwhuijsen, Marileen L P Portegies, M Arfan Ikram, Albert Hofman, Oscar H Franco, Aad van der Lugt, Jolanda J Wentzel, Meike W Vernooij
BACKGROUND AND PURPOSE: Because atherosclerosis is a systemic disease, presence and composition on 1 location may relate to ischemic events in distant locations. We examined whether carotid atherosclerotic wall thickness, stenosis, and plaque composition are related to history of ischemic stroke and coronary heart disease (CHD). METHODS: From the population-based Rotterdam Study, 1731 asymptomatic participants (mean age, 72.4±9.1 years; 55% males) underwent magnetic resonance imaging of both carotid arteries...
June 2016: Stroke; a Journal of Cerebral Circulation
Feiyu Li, Xiaoying Wang
The systemic nature of atherosclerotic disease may entail an association in disease severity between left and right carotid arteries. However, the etiology of plaque features in high-risk lesions is presumably attributed to local risk factors. We explored the symmetry of plaque morphology and composition across a broad range of atherosclerotic disease severities. All participants underwent carotid MR imaging on a 3.0 T scanner with a bilateral four-element phased-array surface coil. Vessel boundary and plaque components [calcification, lipid-rich necrotic core (LRNC) and intraplaque hemorrhage (IPH)] of bilateral carotid arteries were outlined...
August 2016: International Journal of Cardiovascular Imaging
Raf H M van Hoof, Sylvia Heeneman, Joachim E Wildberger, M Eline Kooi
Rupture of a vulnerable atherosclerotic plaque of the carotid artery is an important underlying cause of clinical ischemic events, such as stroke. Abundant microvasculature has been identified as an important aspect contributing to plaque vulnerability. Plaque microvasculature can be studied non-invasively with dynamic contrast-enhanced (DCE-)MRI in animals and patients. In recent years, several DCE-MRI studies have been published evaluating the association between microvasculature and other key features of plaque vulnerability (e...
June 2016: Current Atherosclerosis Reports
Mohammad Reza Najafi, Nafiseh Toghianifar, Morteza Abdar Esfahani, Mohammad Amin Najafi, Mohammad Javad Mollakouchakian
BACKGROUND: Vertebrobasilar dolichoectasia (VBD) is a rare vasculopathy. The etiology of this disease is unknown. Transient ischemic attacks (TIAs) of vertebrobasilar system refer to a transient (< 24 hours) lowering of blood flow in the posterior circulation of the brain. We present a case of dolichoectasia in the vertebrobasilar artery that presented with TIAs. CASE REPORT: A hypertensive 54-year-old man with true vertigo, nausea, imbalance, dysarthria, dysmetria, horizontal nystagmus, and gait ataxia was referred to Alzahra Hospital, Isfahan, Iran...
January 2016: ARYA Atherosclerosis
L B Eisenmenger, B W Aldred, S-E Kim, G J Stoddard, A de Havenon, G S Treiman, D L Parker, J S McNally
BACKGROUND AND PURPOSE: Carotid intraplaque hemorrhage is associated with stroke, plaque thickness, stenosis, ulceration, and adventitial inflammation. Conflicting data exist on whether calcification is a marker of plaque instability, and no data exist on adventitial calcification. Our goal was to determine whether adventitial calcification and soft plaque (a rim sign) help predict carotid intraplaque hemorrhage. MATERIALS AND METHODS: This was a retrospective cohort study of 96 patients who underwent carotid MRA and CTA within 1 month, from 2009 to 2016...
August 2016: AJNR. American Journal of Neuroradiology
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