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Background and Purpose: This study aimed to investigate the arterial disease risk factors for the progression of intraplaque hemorrhage (IPH) in patients with carotid atherosclerosis using serial high-resolution magnetic resonance (MR) imaging. Methods: Consecutive symptomatic patients who had MRI evidence of intraplaque hemorrhage present in the ipsilateral carotid artery with respect to the side of the brain affected by stroke or TIA were recruited in the study. All the patients underwent follow-up MR imaging at least 6 months after baseline. The annual change in IPH and other carotid plaque morphology was calculated, and a tertile method was used to classify the plaques as progressed or not with respect to IPH volume using the software CASCADE. Logistic regression and receiver operating characteristic (ROC) curve were conducted to evaluate the risk factors for the progression of IPH. Results: A total of thirty-four symptomatic patients (mean age: 67.1 years, standard deviation [SD]: 9.8 years, 27 men) were eligible for the final analysis, and contralateral plaques containing IPH were seen in 11 of these patients (making 45 plaques with IPH in total). During mean 16.6-month (SD: 11.0 months) follow-up, the overall annual change in IPH volume in 45 plaques with IPH was mean -10.9 mm3 (SD: 49.1 mm3). Carotid plaques were significantly more likely to be classified in progressed IPH group if the patient was taking antiplatelet agent at baseline (OR: 9.76; 95%CI: 1.05 to 90.56; p = 0.045), had a baseline history of current or past smoking (OR: 9.28; 95%CI: 1.26 to 68.31; p = 0.029), or had a larger baseline carotid plaque-containing vessel wall volume (OR: 1.36 per 10 mm3; 95%CI: 1.02 to 1.81; p = 0.032) after adjustments for confounding factors. ROC analysis indicated that the combination of these three risk factors in the final model produced good discriminatory value for the progressed IPH group (area under the curve: 0.887). Conclusions: Taking an antiplatelet agent at baseline, a baseline history of current or past smoking and larger baseline carotid plaque-containing vessel wall volume were independently predictive of plaques being in the progressed IPH group. Our findings indicate that awareness and management of such risk factors may reduce the risk of intraplaque hemorrhage progression.
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Objective To study the relationship between progression and clinical characteristics of carotid plaques at different sites in elderly carotid atherosclerosis patients.Methods Fifty-one elderly carotid atherosclerosis patients who underwent twice of high resolution MRI in our hospital were included in this study.The MRI data of 75 carotid arteries,annual progression of stenosis,maximum wall thickness,wall size,lumen size at plaques in common carotid artery (CCA),carotid bifurcation (BIF) and internal carotid artery (ICA) were analyzed.Results Of the 131 plaques in 75 carotid arteries,42 were detected in ICA,54 were detected in BIF.The annual progression rates of wall size and maximum wall thickness were higher at plaques in ICA than at those in CCA and BIF (P=0.036,P=0.028).The wall size of plaques in ICA was related with age,hypertension and diabetes (r=0.39,P=0.011;r=0.37,P=0.016;r=0.31,P=0.041).Conclusion The progression of plaques in ICA is faster than that of those in CCA and BIF,and is related with the high clinical risk factors.MRI follow-up can characterize the progressive plaques in elderly carotid atherosclerosis patients.
