TY - JOUR
T1 - Symptomatic Carotid Plaques Demonstrate Less Leaky Plaque Microvasculature Compared With the Contralateral Side
T2 - A Dynamic Contrast-Enhanced Magnetic Resonance Imaging Study
AU - Crombag, Genevieve A. J. C.
AU - van Hoof, Raf H. M.
AU - Holtackers, Robert J.
AU - Schreuder, Floris H. B. M.
AU - Truijman, Martine T. B.
AU - Schreuder, Tobien A. H. C. M. L.
AU - van Orshoven, Narender P.
AU - Mess, Werner H.
AU - Hofman, Paul A. M.
AU - van Oostenbrugge, Robert J.
AU - Wildberger, Joachim E.
AU - Kooi, M. Eline
N1 - Funding Information:
nl), project PARISk (grant 01C-202), and supported by the Dutch Heart Foundation. This project received funding from the European Union (EU) Horizon 2020 Research and Innovation Programme under the Marie Skłodowska-Curie grant agreement No 722609. Wildberger and Kooi are supported by Stichting de Weijerhorst.
Funding Information:
The authors acknowledge the following participating centers: Laurentius Ziekenhuis, Roermond (AG Korten); Viecuri Medisch Centrum, Venlo (BJ Meems); Zuyderland, Sittard/Heerlen (NP van Orshoven/AHCML Schreuder).
Publisher Copyright:
© 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2019/4/16
Y1 - 2019/4/16
N2 - Background-Rupture of a vulnerable carotid atherosclerotic plaque is an important underlying cause of ischemic stroke. Increased leaky plaque microvasculature may contribute to plaque vulnerability. These immature microvessels may facilitate entrance of inflammatory cells into the plaque. The objective of the present study is to investigate whether there is a difference in plaque microvasculature (the volume transfer coefficient K-trans) between the ipsilateral symptomatic and contralateral asymptomatic carotid plaque using noninvasive dynamic contrast-enhanced magnetic resonance imaging.Methods and Results-Eighty-eight patients with recent transient ischemic attack or ischemic stroke and ipsilateral >2 mm carotid plaque underwent 3 T magnetic resonance imaging to identify plaque components and to determine characteristics of plaque microvasculature. The volume transfer coefficient K-trans, indicative for microvascular density, flow, and permeability, was calculated for the ipsilateral and asymptomatic plaque, using a pharmacokinetic model (Patlak). Presence of a lipid-rich necrotic core, intraplaque hemorrhage, and a thin and/or ruptured fibrous cap was assessed on multisequence magnetic resonance imaging. We found significantly lower e ans in the symptomatic carotid plaque compared with the asymptomatic side (0.057 +/- 0.002 min(-1) versus 0.062 +/- 0.002 min(-1); P=0.033). There was an increased number of slices with intraplaque hemorrhage (0.9 +/- 1.6 versus 0.3 +/- 0.8, P=0.002) and lipid-rich necrotic core (1.4 +/- 1.9 versus 0.8 +/- 1.4, P=0.016) and a higher prevalence of plaques with a thin and/or ruptured fibrous cap (32% versus 17%, P=0.023) at the symptomatic side.Conclusions-K-trans was significantly lower in symptomatic carotid plaques, indicative for a decrease of plaque microvasculature in symptomatic plaques. This could be related to a larger amount of necrotic tissue in symptomatic plaques.
AB - Background-Rupture of a vulnerable carotid atherosclerotic plaque is an important underlying cause of ischemic stroke. Increased leaky plaque microvasculature may contribute to plaque vulnerability. These immature microvessels may facilitate entrance of inflammatory cells into the plaque. The objective of the present study is to investigate whether there is a difference in plaque microvasculature (the volume transfer coefficient K-trans) between the ipsilateral symptomatic and contralateral asymptomatic carotid plaque using noninvasive dynamic contrast-enhanced magnetic resonance imaging.Methods and Results-Eighty-eight patients with recent transient ischemic attack or ischemic stroke and ipsilateral >2 mm carotid plaque underwent 3 T magnetic resonance imaging to identify plaque components and to determine characteristics of plaque microvasculature. The volume transfer coefficient K-trans, indicative for microvascular density, flow, and permeability, was calculated for the ipsilateral and asymptomatic plaque, using a pharmacokinetic model (Patlak). Presence of a lipid-rich necrotic core, intraplaque hemorrhage, and a thin and/or ruptured fibrous cap was assessed on multisequence magnetic resonance imaging. We found significantly lower e ans in the symptomatic carotid plaque compared with the asymptomatic side (0.057 +/- 0.002 min(-1) versus 0.062 +/- 0.002 min(-1); P=0.033). There was an increased number of slices with intraplaque hemorrhage (0.9 +/- 1.6 versus 0.3 +/- 0.8, P=0.002) and lipid-rich necrotic core (1.4 +/- 1.9 versus 0.8 +/- 1.4, P=0.016) and a higher prevalence of plaques with a thin and/or ruptured fibrous cap (32% versus 17%, P=0.023) at the symptomatic side.Conclusions-K-trans was significantly lower in symptomatic carotid plaques, indicative for a decrease of plaque microvasculature in symptomatic plaques. This could be related to a larger amount of necrotic tissue in symptomatic plaques.
KW - angiogenesis
KW - atherosclerosis
KW - ischemic stroke
KW - magnetic resonance imaging
KW - ADVENTITIAL VASA VASORUM
KW - NECROTIC CORE SIZE
KW - ATHEROSCLEROTIC PLAQUE
KW - INTRAPLAQUE HEMORRHAGE
KW - DCE-MRI
KW - CEREBROVASCULAR EVENTS
KW - HIGH-RESOLUTION
KW - FIBROUS CAP
KW - ANGIOGENESIS
KW - INFLAMMATION
U2 - 10.1161/JAHA.118.011832
DO - 10.1161/JAHA.118.011832
M3 - Article
C2 - 30971168
SN - 2047-9980
VL - 8
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 8
M1 - 011832
ER -