Andreas Dietrich Helck MD, Presenter: Nothing to Disclose

Martin Buchholz, Abstract Co-Author: Nothing to Disclose

Konstantin Nikolaou MD, Abstract Co-Author: Speakers Bureau, Siemens AG Speakers Bureau, Bracco Group Speakers Bureau, Bayer AG

Martin Dichgans MD, Abstract Co-Author: Nothing to Disclose

Chun Yuan PhD, Abstract Co-Author: Research Grant, Koninklijke Philips Electronics NV Research Grant, VP Diagnostics, Inc Consultant, ImagePace LLC Consultant, Bristol Myers Squibb Medical Imaging

Tobias Saam MD, Abstract Co-Author: Research Grant, Diamed Medizintechnik GmbH Research Grant, Bayer AG

Mike Notohamiprodjo, Abstract Co-Author: Nothing to Disclose

Maximilian F. Reiser MD, Abstract Co-Author: Nothing to Disclose

Marcus Treitl MD, Abstract Co-Author: Nothing to Disclose

Anna Karpinska, Abstract Co-Author: Nothing to Disclose

Axel Rominger, Abstract Co-Author: Nothing to Disclose

Positive (expansive) remodeling is considered to be a feature of the vulnerable atherosclerotic plaque in the coronary arteries. Most of our knowledge of carotid lesions is based on endarterectomy specimens which do not provide insight into remodeling patterns. Via in vivo magnetic resonance imaging (MRI), we sought to evaluate the association between ischemic stroke and expansive carotid remodeling.

54 patients (17 female, 37 male, 71±10,7y) with carotid plaques and ≥2 mm thickness by duplex sonography and unilateral ischemic stroke in the territory of the internal carotid artery were included. All patients received a black-blood carotid MRI at 3.0-Tesla with fat-saturated pre- and post-contrast T1w-, PDw-, T2w- and TOF images using surface coils and Parallel Imaging techniques. Quantitative measurements of lumen, wall, outer wall, hemorrhage, calcification and necrotic core were determined by the consensus opinion of 2 experienced carotid MRI reviewers for both sides and for the common and internal carotid artery (CCA / ICA), respectively. The modified remodeling index (RI) was calculated by dividing the outer vessel area at the site of the carotid plaque by the lumen area measured on TOF images in a normal reference segment distally (for ICA) or proximal (for CCA).

The CCA on the symptomatic side had compared to the asymptomatic side significantly larger maximum necrotic core and hemorrhage areas (P<0.01) No other significant differences were found. The ICA on the symptomatic side had compared to the asymptomatic significantly larger wall, maximum necrotic core and hemorrhage areas (P<0.01). No other significant differences were found. More specifically, the modified remodeling index did not differ significantly in the CCA (1.61 vs. 1.61; P=0.8) nor the ICA (2.57 vs. 2.34; P=0.23).

In this series of subjects no association was found between expansive remodeling and ischemic stroke.

This study suggests that positive remodeling plays a minor role in the development of vulnerable lesions and could help to assess the risk for ischemic events in patients with carotid artery disease.

Helck, A, Buchholz, M, Nikolaou, K, Dichgans, M, Yuan, C, Saam, T, Notohamiprodjo, M, Reiser, M, Treitl, M, Karpinska, A, Rominger, A, Expansive Arterial Remodeling: A Marker of Plaque Vulnerability in the Carotid Arteries? An in vivo MRI Study of the Carotid Arteries.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12033481.html