Background
The aim of this study was to validate the relationship between carotid artery remodeling
defined as the carotid remodeling index (CRI) and plaque vulnerability by comparing
the degree of outward remodeling calculated using 3-dimensional inversion recovery-based
T1-weighted imaging (magnetization-prepared rapid acquisition gradient echo [MPRAGE])
with the symptomatology and histology of plaques extracted during carotid endarterectomy.
Methods
Sixty-one patients with 50% stenosis or more (North American Symptomatic Carotid Endarterectomy
Trial criteria) were included. The average rate of stenosis was 79.8%. The CRI was
determined by measuring the external cross-sectional vessel area (CSVA) at the maximum
stenosis of the internal carotid artery (ICA) and dividing it by the external CSVA
at the distal ICA (unaffected by atherosclerosis) using MPRAGE imaging.
Results
The CRI was significantly higher in symptomatic patients compared with asymptomatic
patients (1.98 ± .26 versus 1.68 ± .24, P < .0001). A higher CRI positively correlated with the necrotic core area (r = .57, P < .0001) and negatively correlated with the fibrous cap thickness (r = −.33, P = .01). It was also significantly associated with severe intraplaque hemorrhage (P < .0001) and the prevalence of cap inflammation with macrophage (P = .03) and lymphocyte (P = .01) infiltration.
Conclusions
The larger outward remodeling of the carotid artery on MPRAGE imaging had symptomatic
carotid plaques and histologically vulnerable plaques. This study indicates that MPRAGE
imaging is useful for the assessment of carotid artery remodeling.
Key Words
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Article info
Publication history
Published online: March 03, 2014
Accepted:
December 6,
2013
Received in revised form:
December 6,
2013
Received:
July 16,
2013
Footnotes
Grant support: None.
Disclosure: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this article.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.12.010
Copyright
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
