Cargando…
Symptomatic Carotid Plaques Demonstrate Less Leaky Plaque Microvasculature Compared With the Contralateral Side: A Dynamic Contrast‐Enhanced Magnetic Resonance Imaging Study
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 objec...
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6507193/ https://www.ncbi.nlm.nih.gov/pubmed/30971168 http://dx.doi.org/10.1161/JAHA.118.011832 |
_version_ | 1783416981292056576 |
---|---|
author | Crombag, Geneviève A. J. C. van Hoof, Raf H. M. Holtackers, Robert J. Schreuder, Floris H. B. M. Truijman, Martine T. B. Schreuder, Tobien A. H. C. M. L. van Orshoven, Narender P. Mess, Werner H. Hofman, Paul A. M. van Oostenbrugge, Robert J. Wildberger, Joachim E. Kooi, M. Eline |
author_facet | Crombag, Geneviève A. J. C. van Hoof, Raf H. M. Holtackers, Robert J. Schreuder, Floris H. B. M. Truijman, Martine T. B. Schreuder, Tobien A. H. C. M. L. van Orshoven, Narender P. Mess, Werner H. Hofman, Paul A. M. van Oostenbrugge, Robert J. Wildberger, Joachim E. Kooi, M. Eline |
author_sort | Crombag, Geneviève A. J. C. |
collection | PubMed |
description | 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 K (trans) 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. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov.uk. Unique identifier: NCT01208025. |
format | Online Article Text |
id | pubmed-6507193 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-65071932019-05-13 Symptomatic Carotid Plaques Demonstrate Less Leaky Plaque Microvasculature Compared With the Contralateral Side: A Dynamic Contrast‐Enhanced Magnetic Resonance Imaging Study Crombag, Geneviève A. J. C. van Hoof, Raf H. M. Holtackers, Robert J. Schreuder, Floris H. B. M. Truijman, Martine T. B. Schreuder, Tobien A. H. C. M. L. van Orshoven, Narender P. Mess, Werner H. Hofman, Paul A. M. van Oostenbrugge, Robert J. Wildberger, Joachim E. Kooi, M. Eline J Am Heart Assoc Original Research 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 K (trans) 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. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov.uk. Unique identifier: NCT01208025. John Wiley and Sons Inc. 2019-04-11 /pmc/articles/PMC6507193/ /pubmed/30971168 http://dx.doi.org/10.1161/JAHA.118.011832 Text en © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Research Crombag, Geneviève A. J. C. van Hoof, Raf H. M. Holtackers, Robert J. Schreuder, Floris H. B. M. Truijman, Martine T. B. Schreuder, Tobien A. H. C. M. L. van Orshoven, Narender P. Mess, Werner H. Hofman, Paul A. M. van Oostenbrugge, Robert J. Wildberger, Joachim E. Kooi, M. Eline Symptomatic Carotid Plaques Demonstrate Less Leaky Plaque Microvasculature Compared With the Contralateral Side: A Dynamic Contrast‐Enhanced Magnetic Resonance Imaging Study |
title | Symptomatic Carotid Plaques Demonstrate Less Leaky Plaque Microvasculature Compared With the Contralateral Side: A Dynamic Contrast‐Enhanced Magnetic Resonance Imaging Study |
title_full | Symptomatic Carotid Plaques Demonstrate Less Leaky Plaque Microvasculature Compared With the Contralateral Side: A Dynamic Contrast‐Enhanced Magnetic Resonance Imaging Study |
title_fullStr | Symptomatic Carotid Plaques Demonstrate Less Leaky Plaque Microvasculature Compared With the Contralateral Side: A Dynamic Contrast‐Enhanced Magnetic Resonance Imaging Study |
title_full_unstemmed | Symptomatic Carotid Plaques Demonstrate Less Leaky Plaque Microvasculature Compared With the Contralateral Side: A Dynamic Contrast‐Enhanced Magnetic Resonance Imaging Study |
title_short | Symptomatic Carotid Plaques Demonstrate Less Leaky Plaque Microvasculature Compared With the Contralateral Side: A Dynamic Contrast‐Enhanced Magnetic Resonance Imaging Study |
title_sort | symptomatic carotid plaques demonstrate less leaky plaque microvasculature compared with the contralateral side: a dynamic contrast‐enhanced magnetic resonance imaging study |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6507193/ https://www.ncbi.nlm.nih.gov/pubmed/30971168 http://dx.doi.org/10.1161/JAHA.118.011832 |
work_keys_str_mv | AT crombaggenevieveajc symptomaticcarotidplaquesdemonstratelessleakyplaquemicrovasculaturecomparedwiththecontralateralsideadynamiccontrastenhancedmagneticresonanceimagingstudy AT vanhoofrafhm symptomaticcarotidplaquesdemonstratelessleakyplaquemicrovasculaturecomparedwiththecontralateralsideadynamiccontrastenhancedmagneticresonanceimagingstudy AT holtackersrobertj symptomaticcarotidplaquesdemonstratelessleakyplaquemicrovasculaturecomparedwiththecontralateralsideadynamiccontrastenhancedmagneticresonanceimagingstudy AT schreuderflorishbm symptomaticcarotidplaquesdemonstratelessleakyplaquemicrovasculaturecomparedwiththecontralateralsideadynamiccontrastenhancedmagneticresonanceimagingstudy AT truijmanmartinetb symptomaticcarotidplaquesdemonstratelessleakyplaquemicrovasculaturecomparedwiththecontralateralsideadynamiccontrastenhancedmagneticresonanceimagingstudy AT schreudertobienahcml symptomaticcarotidplaquesdemonstratelessleakyplaquemicrovasculaturecomparedwiththecontralateralsideadynamiccontrastenhancedmagneticresonanceimagingstudy AT vanorshovennarenderp symptomaticcarotidplaquesdemonstratelessleakyplaquemicrovasculaturecomparedwiththecontralateralsideadynamiccontrastenhancedmagneticresonanceimagingstudy AT messwernerh symptomaticcarotidplaquesdemonstratelessleakyplaquemicrovasculaturecomparedwiththecontralateralsideadynamiccontrastenhancedmagneticresonanceimagingstudy AT hofmanpaulam symptomaticcarotidplaquesdemonstratelessleakyplaquemicrovasculaturecomparedwiththecontralateralsideadynamiccontrastenhancedmagneticresonanceimagingstudy AT vanoostenbruggerobertj symptomaticcarotidplaquesdemonstratelessleakyplaquemicrovasculaturecomparedwiththecontralateralsideadynamiccontrastenhancedmagneticresonanceimagingstudy AT wildbergerjoachime symptomaticcarotidplaquesdemonstratelessleakyplaquemicrovasculaturecomparedwiththecontralateralsideadynamiccontrastenhancedmagneticresonanceimagingstudy AT kooimeline symptomaticcarotidplaquesdemonstratelessleakyplaquemicrovasculaturecomparedwiththecontralateralsideadynamiccontrastenhancedmagneticresonanceimagingstudy |