Robert Michael Kwee, Presenter: Nothing to Disclose

Robert Van Oostenbrugge, Abstract Co-Author: Nothing to Disclose

Werner Mess, Abstract Co-Author: Nothing to Disclose

Jos van Engelshoven MD, PhD, Abstract Co-Author: Nothing to Disclose

Joachim Ernst Wildberger MD, Abstract Co-Author: Nothing to Disclose

Eline Kooi, Abstract Co-Author: Research support, Koninklijke Philips Electronics NV

There is a need for improved risk stratification of TIA and stroke patients with carotid atherosclerosis. The purpose of the present study was to prospectively investigate whether certain MRI-based carotid plaque characteristics are associated with recurrent ischemic events.

One hundred TIA/stroke patients with ipsilateral 30-69% carotid stenosis underwent multisequence MRI, including contrast-enhanced images, of the carotid plaque within 32.7±19.9 days after the initial event. For each plaque, vessel wall volume and volumes of lipid-rich necrotic core (LRNC), calcifications, and fibrous tissue were assessed. Maximum vessel wall thickness, minimum lumen area, fibrous cap status, and intraplaque hemorrhage (IPH) were also assessed. Patients were followed by structured interviews and chart review to determine the recurrence of ipsilateral TIA and/or ischemic stroke within one year.

Ten of hundred included patients suffered from recurrent ipsilateral clinical ischemic events (9 TIAs and 1 ischemic stroke). The presence of IPH was associated with recurrence (Pearson Chi-Square= 7.373, P=0.007). Patients with recurrent events also had plaques with larger LRNC volume and larger maximum vessel wall thickness, although these findings were borderline significant (P=0.032 and P=0.055, respectively). Other MRI-based parameters were not related to recurrent ischemic events.

The results of this study indicate that the presence of IPH, larger LRNC volume, and larger maximum vessel wall thickness of carotid plaques are associated with recurrent TIA and ischemic stroke. Assessment of carotid plaque characteristics by MRI may help identifying high-risk patients, which could improve patient selection for carotid endarterectomy or stenting.

Assessment of carotid plaque characteristics by MRI may help identifying TIA and stroke patients with carotid stenosis who are at increased risk of a recurrence.

Kwee, R, Van Oostenbrugge, R, Mess, W, van Engelshoven, J, Wildberger, J, Kooi, E, TIA and Stroke Patients with Carotid Stenosis: Presence of Complicated Plaque Features at MRI Is Associated with Recurrent Events.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11012466.html