Proximal Region of Carotid Atherosclerotic Plaque Shows More Intraplaque Hemorrhage: The Plaque at Risk Study

G. A. J. C. Crombag; M. Aizaz; F. H. B. M. Schreuder; F. Benali; D. H. K. Van Dam-Nolen; M. I. L. Liem; C. Lucci; A. F. van der Steen; M. J. A. P. Daemen; W. H. Mess; A. van der Lugt; P. J. Nederkoorn; J. Hendrikse; P. A. M. Hofman; R. J. van Oostenbrugge; J. E. Wildberger; M. E. Kooi

doi:10.3174/ajnr.A7384

Proximal Region of Carotid Atherosclerotic Plaque Shows More Intraplaque Hemorrhage: The Plaque at Risk Study

G. A. J. C. Crombag, M. Aizaz, F. H. B. M. Schreuder, F. Benali, D. H. K. Van Dam-Nolen, M. I. L. Liem, C. Lucci, A. F. van der Steen, M. J. A. P. Daemen, W. H. Mess, A. van der Lugt, P. J. Nederkoorn, J. Hendrikse, P. A. M. Hofman, R. J. van Oostenbrugge, J. E. Wildberger, M. E. Kooi

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Abstract

BACKGROUND AND PURPOSE: Intraplaque hemorrhage contributes to lipid core enlargement and plaque progression, leading to plaque destabilization and stroke. The mechanisms that contribute to the development of intraplaque hemorrhage are not completely understood. A higher incidence of intraplaque hemorrhage and thin/ruptured fibrous cap (upstream of the maximum stenosis in patients with severe [≥70%] carotid stenosis) has been reported. We aimed to noninvasively study the distribution of intraplaque hemorrhage and a thin/ruptured fibrous cap in patients with mild-to-moderate carotid stenosis. MATERIALS AND METHODS: Eighty-eight symptomatic patients with stroke (,70% carotid stenosis included in the Plaque at Risk study) demonstrated intraplaque hemorrhage on MR imaging in the carotid artery plaque ipsilateral to the side of TIA/stroke. The intraplaque hemorrhage area percentage was calculated. A thin/ruptured fibrous cap was scored by comparing pre- and postcontrast black-blood TSE images. Differences in mean intraplaque hemorrhage percentages between the proximal and distal regions were compared using a paired-samples t test. The McNemar test was used to reveal differences in proportions of a thin/ruptured fibrous cap. RESULTS: We found significantly larger areas of intraplaque hemorrhage in the proximal part of the plaque at 2, 4, and 6 mm from the maximal luminal narrowing, respectively: 14.4% versus 9.6% (P = .04), 14.7% versus 5.4% (P, .001), and 11.1% versus 2.2% (P = .001). Additionally, we found an increased proximal prevalence of a thin/ruptured fibrous cap on MR imaging at 2, 4, 6, and 8 mm from the MR imaging section with the maximal luminal narrowing, respectively: 33.7% versus 18.1%, P = .007; 36.1% versus 7.2%, P, .001; 33.7% versus 2.4%, P = .001; and 30.1% versus 3.6%, P = .022. CONCLUSIONS: We demonstrated that intraplaque hemorrhage and a thin/ruptured fibrous cap are more prevalent on the proximal side of the plaque compared with the distal side in patients with mild-to-moderate carotid stenosis.

Original language	English
Pages (from-to)	265-271
Number of pages	7
Journal	American Journal of Neuroradiology
Volume	43
Issue number	2
DOIs	https://doi.org/10.3174/ajnr.A7384
Publication status	Published - Feb 2022

Bibliographical note

Funding Information:
This work was supported by the Center for Translational Molecular Medicine (www. ctmm.nl), project PARISK (grant 01C-202), and the Netherlands Heart Foundation. This project has received funding from the European Union Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement No 722609. M.E. Kooi is supported by an Aspasia Grant 2018/SGw/00460457 from Nederlandse Organisatie voor Wetenschappelijk Onderzoek. J. Hendrikse received funding from the European Research Council under the European Union’s Horizon 2020 program (H2020)/European Research Council grant agreement No. 637024. F.H.B.M. Schreuder is supported by the Netherlands Heart Foundation (2019T060). Please address correspondence to M. Eline Kooi, MD, Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, the Netherlands; e-mail: eline.kooi@mumc.nl

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© 2022 American Society of Neuroradiology. All rights reserved.

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Proximal Region of Carotid Atherosclerotic Plaque Shows More Intraplaque HemorrhageFinal published version, 1.15 MBLicence: Unspecified
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Crombag, G. A. J. C., Aizaz, M., Schreuder, F. H. B. M., Benali, F., Van Dam-Nolen, D. H. K., Liem, M. I. L., Lucci, C., van der Steen, A. F., Daemen, M. J. A. P., Mess, W. H., van der Lugt, A., Nederkoorn, P. J., Hendrikse, J., Hofman, P. A. M., van Oostenbrugge, R. J., Wildberger, J. E., & Kooi, M. E. (2022). Proximal Region of Carotid Atherosclerotic Plaque Shows More Intraplaque Hemorrhage: The Plaque at Risk Study. American Journal of Neuroradiology, 43(2), 265-271. https://doi.org/10.3174/ajnr.A7384

@article{ef01f3c16436405b86795a072b309609,

title = "Proximal Region of Carotid Atherosclerotic Plaque Shows More Intraplaque Hemorrhage: The Plaque at Risk Study",

abstract = "BACKGROUND AND PURPOSE: Intraplaque hemorrhage contributes to lipid core enlargement and plaque progression, leading to plaque destabilization and stroke. The mechanisms that contribute to the development of intraplaque hemorrhage are not completely understood. A higher incidence of intraplaque hemorrhage and thin/ruptured fibrous cap (upstream of the maximum stenosis in patients with severe [≥70%] carotid stenosis) has been reported. We aimed to noninvasively study the distribution of intraplaque hemorrhage and a thin/ruptured fibrous cap in patients with mild-to-moderate carotid stenosis. MATERIALS AND METHODS: Eighty-eight symptomatic patients with stroke (,70% carotid stenosis included in the Plaque at Risk study) demonstrated intraplaque hemorrhage on MR imaging in the carotid artery plaque ipsilateral to the side of TIA/stroke. The intraplaque hemorrhage area percentage was calculated. A thin/ruptured fibrous cap was scored by comparing pre- and postcontrast black-blood TSE images. Differences in mean intraplaque hemorrhage percentages between the proximal and distal regions were compared using a paired-samples t test. The McNemar test was used to reveal differences in proportions of a thin/ruptured fibrous cap. RESULTS: We found significantly larger areas of intraplaque hemorrhage in the proximal part of the plaque at 2, 4, and 6 mm from the maximal luminal narrowing, respectively: 14.4% versus 9.6% (P = .04), 14.7% versus 5.4% (P, .001), and 11.1% versus 2.2% (P = .001). Additionally, we found an increased proximal prevalence of a thin/ruptured fibrous cap on MR imaging at 2, 4, 6, and 8 mm from the MR imaging section with the maximal luminal narrowing, respectively: 33.7% versus 18.1%, P = .007; 36.1% versus 7.2%, P, .001; 33.7% versus 2.4%, P = .001; and 30.1% versus 3.6%, P = .022. CONCLUSIONS: We demonstrated that intraplaque hemorrhage and a thin/ruptured fibrous cap are more prevalent on the proximal side of the plaque compared with the distal side in patients with mild-to-moderate carotid stenosis.",

author = "Crombag, {G. A. J. C.} and M. Aizaz and Schreuder, {F. H. B. M.} and F. Benali and {Van Dam-Nolen}, {D. H. K.} and Liem, {M. I. L.} and C. Lucci and {van der Steen}, {A. F.} and Daemen, {M. J. A. P.} and Mess, {W. H.} and {van der Lugt}, A. and Nederkoorn, {P. J.} and J. Hendrikse and Hofman, {P. A. M.} and {van Oostenbrugge}, {R. J.} and Wildberger, {J. E.} and Kooi, {M. E.}",

note = "Funding Information: This work was supported by the Center for Translational Molecular Medicine (www. ctmm.nl), project PARISK (grant 01C-202), and the Netherlands Heart Foundation. This project has received funding from the European Union Horizon 2020 research and innovation program under the Marie Sk{\l}odowska-Curie grant agreement No 722609. M.E. Kooi is supported by an Aspasia Grant 2018/SGw/00460457 from Nederlandse Organisatie voor Wetenschappelijk Onderzoek. J. Hendrikse received funding from the European Research Council under the European Union{\textquoteright}s Horizon 2020 program (H2020)/European Research Council grant agreement No. 637024. F.H.B.M. Schreuder is supported by the Netherlands Heart Foundation (2019T060). Please address correspondence to M. Eline Kooi, MD, Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, the Netherlands; e-mail: eline.kooi@mumc.nl Publisher Copyright: {\textcopyright} 2022 American Society of Neuroradiology. All rights reserved.",

year = "2022",

month = feb,

doi = "10.3174/ajnr.A7384",

language = "English",

volume = "43",

pages = "265--271",

journal = "American Journal of Neuroradiology",

issn = "0195-6108",

publisher = "American Society of Neuroradiology",

number = "2",

}

Crombag, GAJC, Aizaz, M, Schreuder, FHBM, Benali, F , Van Dam-Nolen, DHK, Liem, MIL, Lucci, C, van der Steen, AF, Daemen, MJAP, Mess, WH, van der Lugt, A, Nederkoorn, PJ, Hendrikse, J, Hofman, PAM, van Oostenbrugge, RJ, Wildberger, JE & Kooi, ME 2022, 'Proximal Region of Carotid Atherosclerotic Plaque Shows More Intraplaque Hemorrhage: The Plaque at Risk Study', American Journal of Neuroradiology, vol. 43, no. 2, pp. 265-271. https://doi.org/10.3174/ajnr.A7384

TY - JOUR

T1 - Proximal Region of Carotid Atherosclerotic Plaque Shows More Intraplaque Hemorrhage

T2 - The Plaque at Risk Study

AU - Crombag, G. A. J. C.

AU - Aizaz, M.

AU - Schreuder, F. H. B. M.

AU - Benali, F.

AU - Van Dam-Nolen, D. H. K.

AU - Liem, M. I. L.

AU - Lucci, C.

AU - van der Steen, A. F.

AU - Daemen, M. J. A. P.

AU - Mess, W. H.

AU - van der Lugt, A.

AU - Nederkoorn, P. J.

AU - Hendrikse, J.

AU - Hofman, P. A. M.

AU - van Oostenbrugge, R. J.

AU - Wildberger, J. E.

AU - Kooi, M. E.

N1 - Funding Information: This work was supported by the Center for Translational Molecular Medicine (www. ctmm.nl), project PARISK (grant 01C-202), and the Netherlands Heart Foundation. This project has received funding from the European Union Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement No 722609. M.E. Kooi is supported by an Aspasia Grant 2018/SGw/00460457 from Nederlandse Organisatie voor Wetenschappelijk Onderzoek. J. Hendrikse received funding from the European Research Council under the European Union’s Horizon 2020 program (H2020)/European Research Council grant agreement No. 637024. F.H.B.M. Schreuder is supported by the Netherlands Heart Foundation (2019T060). Please address correspondence to M. Eline Kooi, MD, Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, the Netherlands; e-mail: eline.kooi@mumc.nl Publisher Copyright: © 2022 American Society of Neuroradiology. All rights reserved.

PY - 2022/2

Y1 - 2022/2

N2 - BACKGROUND AND PURPOSE: Intraplaque hemorrhage contributes to lipid core enlargement and plaque progression, leading to plaque destabilization and stroke. The mechanisms that contribute to the development of intraplaque hemorrhage are not completely understood. A higher incidence of intraplaque hemorrhage and thin/ruptured fibrous cap (upstream of the maximum stenosis in patients with severe [≥70%] carotid stenosis) has been reported. We aimed to noninvasively study the distribution of intraplaque hemorrhage and a thin/ruptured fibrous cap in patients with mild-to-moderate carotid stenosis. MATERIALS AND METHODS: Eighty-eight symptomatic patients with stroke (,70% carotid stenosis included in the Plaque at Risk study) demonstrated intraplaque hemorrhage on MR imaging in the carotid artery plaque ipsilateral to the side of TIA/stroke. The intraplaque hemorrhage area percentage was calculated. A thin/ruptured fibrous cap was scored by comparing pre- and postcontrast black-blood TSE images. Differences in mean intraplaque hemorrhage percentages between the proximal and distal regions were compared using a paired-samples t test. The McNemar test was used to reveal differences in proportions of a thin/ruptured fibrous cap. RESULTS: We found significantly larger areas of intraplaque hemorrhage in the proximal part of the plaque at 2, 4, and 6 mm from the maximal luminal narrowing, respectively: 14.4% versus 9.6% (P = .04), 14.7% versus 5.4% (P, .001), and 11.1% versus 2.2% (P = .001). Additionally, we found an increased proximal prevalence of a thin/ruptured fibrous cap on MR imaging at 2, 4, 6, and 8 mm from the MR imaging section with the maximal luminal narrowing, respectively: 33.7% versus 18.1%, P = .007; 36.1% versus 7.2%, P, .001; 33.7% versus 2.4%, P = .001; and 30.1% versus 3.6%, P = .022. CONCLUSIONS: We demonstrated that intraplaque hemorrhage and a thin/ruptured fibrous cap are more prevalent on the proximal side of the plaque compared with the distal side in patients with mild-to-moderate carotid stenosis.

AB - BACKGROUND AND PURPOSE: Intraplaque hemorrhage contributes to lipid core enlargement and plaque progression, leading to plaque destabilization and stroke. The mechanisms that contribute to the development of intraplaque hemorrhage are not completely understood. A higher incidence of intraplaque hemorrhage and thin/ruptured fibrous cap (upstream of the maximum stenosis in patients with severe [≥70%] carotid stenosis) has been reported. We aimed to noninvasively study the distribution of intraplaque hemorrhage and a thin/ruptured fibrous cap in patients with mild-to-moderate carotid stenosis. MATERIALS AND METHODS: Eighty-eight symptomatic patients with stroke (,70% carotid stenosis included in the Plaque at Risk study) demonstrated intraplaque hemorrhage on MR imaging in the carotid artery plaque ipsilateral to the side of TIA/stroke. The intraplaque hemorrhage area percentage was calculated. A thin/ruptured fibrous cap was scored by comparing pre- and postcontrast black-blood TSE images. Differences in mean intraplaque hemorrhage percentages between the proximal and distal regions were compared using a paired-samples t test. The McNemar test was used to reveal differences in proportions of a thin/ruptured fibrous cap. RESULTS: We found significantly larger areas of intraplaque hemorrhage in the proximal part of the plaque at 2, 4, and 6 mm from the maximal luminal narrowing, respectively: 14.4% versus 9.6% (P = .04), 14.7% versus 5.4% (P, .001), and 11.1% versus 2.2% (P = .001). Additionally, we found an increased proximal prevalence of a thin/ruptured fibrous cap on MR imaging at 2, 4, 6, and 8 mm from the MR imaging section with the maximal luminal narrowing, respectively: 33.7% versus 18.1%, P = .007; 36.1% versus 7.2%, P, .001; 33.7% versus 2.4%, P = .001; and 30.1% versus 3.6%, P = .022. CONCLUSIONS: We demonstrated that intraplaque hemorrhage and a thin/ruptured fibrous cap are more prevalent on the proximal side of the plaque compared with the distal side in patients with mild-to-moderate carotid stenosis.

UR - http://www.scopus.com/inward/record.url?scp=85124172758&partnerID=8YFLogxK

U2 - 10.3174/ajnr.A7384

DO - 10.3174/ajnr.A7384

M3 - Article

C2 - 35121587

SN - 0195-6108

VL - 43

SP - 265

EP - 271

JO - American Journal of Neuroradiology

JF - American Journal of Neuroradiology

IS - 2

ER -

Proximal Region of Carotid Atherosclerotic Plaque Shows More Intraplaque Hemorrhage: The Plaque at Risk Study

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