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*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Web of Science)


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 languageEnglish
Pages (from-to)265-271
Number of pages7
JournalAmerican Journal of Neuroradiology
Issue number2
Publication statusPublished - 1 Feb 2022


  • MRI

Cite this