scholarly journals Carotid MRI Detection of Intraplaque Hemorrhage at 3T and 1.5T

2014 ◽  
Vol 25 (3) ◽  
pp. 390-396 ◽  
Author(s):  
J. Scott McNally ◽  
Hyo-Chun Yoon ◽  
Seong-Eun Kim ◽  
Krishna K. Narra ◽  
Michael S. McLaughlin ◽  
...  
Keyword(s):  
Intraplaque Hemorrhage ◽  
Carotid Mri

scholarly journals Semiautomatic carotid intraplaque hemorrhage volume measurement using 3D carotid MRI

2019 ◽  
Vol 50 (4) ◽  
pp. 1055-1062 ◽  
Author(s):  
Jin Liu ◽  
Jie Sun ◽  
Niranjan Balu ◽  
Marina S. Ferguson ◽  
Jinnan Wang ◽  
...  
Keyword(s):  
Volume Measurement ◽  
Intraplaque Hemorrhage ◽  
Carotid Mri ◽  
Hemorrhage Volume

Identifying a high risk cardiovascular phenotype by carotid MRI-depicted intraplaque hemorrhage

2013 ◽  
Vol 29 (7) ◽  
pp. 1477-1483 ◽  
Author(s):  
Navneet Singh ◽  
Alan R. Moody ◽  
Geneviéve Rochon-Terry ◽  
Alexander Kiss ◽  
Anna Zavodni
Keyword(s):  
High Risk ◽  
Intraplaque Hemorrhage ◽  
Carotid Mri

Abstract 98: Bilateral Carotid Intraplaque Hemorrhage Association With Simultaneous Bilateral Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Michael McLaughlin ◽  
Seong-Eun Kim ◽  
Gerald Treiman ◽  
Dennis Parker ◽  
Joseph S McNally
Keyword(s):  
Predictive Value ◽  
Brain Mri ◽  
Area Under The Curve ◽  
Cross Sectional Study ◽  
Intraplaque Hemorrhage ◽  
Imaging Findings ◽  
Cross Sectional ◽  
Carotid Mri ◽  
Bilateral Carotid ◽  
Better Than

Introduction: Bilateral ischemic strokes are often attributed to central or cardiac embolic sources, especially in the absence of severe bilateral carotid stenosis. Carotid MRI detects carotid intraplaque hemorrhage (IPH), a marker of stroke risk independent of stenosis. Hypothesis: MRI-detected carotid IPH better identifies bilateral carotid source strokes compared to stenosis alone. Methods: In this retrospective cross sectional study, patients undergoing stroke workup were imaged with carotid and brain MRI. Stroke was determined by the AHA definition of CNS infarction. Patients with non-carotid stroke sources (e.g. cardiac sources), occluded or near-occluded carotids were excluded. A total of 425 patients were analyzed. Carotid imaging findings were recorded, including IPH and NASCET stenosis along with clinical cerebrovascular risk factors and medications. Receiver operating characteristic (ROC) analysis was performed to determine the predictive value (area under the curve, AUC) of carotid imaging findings. Results: Carotid IPH was present in 89/425 of cases, and was bilateral in 24/89 (27.0%). Bilateral carotid IPH was a good predictor of bilateral stroke (AUC=.808), performing better than bilateral stenosis with ≥50%, ≥60% or ≥70% cutoffs (AUC=.565 p=.001, AUC=.550 p<.001, AUC=.523 p<.001, respectively) but not significantly better than average bilateral stenosis (AUC=.800 p=.90). The combined predictive value of bilateral IPH and average bilateral stenosis was excellent (AUC=.891) and performed better than bilateral IPH alone (p=.07) or average bilateral stenosis alone (p=.002). Conclusions: Bilateral carotid IPH is associated with bilateral stroke, and adds significant discrimination of bilateral carotid stroke sources compared to stenosis. In the setting of bilateral stroke, carotid MRI may help uncover potential stroke sources undetected by lumen imaging alone.

Abstract TP134: Carotid Endarterectomy for Symptomatic Low-grade Stenosis Refractory to Medical Treatment

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kazumichi Yoshida
Keyword(s):  
Medical Treatment ◽  
Carotid Endarterectomy ◽  
Intraplaque Hemorrhage ◽  
Low Grade ◽  
High Grade ◽  
Long Term Outcomes ◽  
Diffusion Weighted Images ◽  
Stenosis Rate ◽  
Carotid Mri

Background and purpose: Several large multicenter trials have demonstrated that carotid endarterectomy (CEA) benefits patients with symptomatic moderate-to-high-grade carotid stenosis (CS), but not those with low-grade CS. Accumulating evidence from vascular biology studies indicates that plaque stability in addition to stenosis rate considerably impacts risk for ischemic events. The present study aimed to determine the characteristics of symptomatic low-grade CS that was refractory to medical treatment and confirm the safety and efficacy of CEA. Methods: We studied 61 (male, n = 54; mean age, 71.0 ± 6.5 years) consecutive patients with symptomatic CS who underwent CEA. The patients’ characteristics, preoperative carotid MRI plaque imaging findings, and short- and long-term outcomes after CEA were compared between those with low-grade CS (< 50%, n = 17) and those with moderate-to-high grade CS (≥ 50%, n = 44). Plaque excised from patients with low-grade CS was also histologically assessed. We considered CEA to treat low-grade CS when recurrence was refractory to aggressive medical approaches. Results: The characteristics did not significantly differ between patients with low-grade and moderate-to-high-grade CS. The degree to which MRI detected intraplaque hemorrhage was significantly higher (P = 0.04) and the extent of expansive arterial remodeling tended to be higher (P = 0.18) in patients with low-grade CS. Intraplaque hemorrhage was confirmed in all 17 excised plaques from patients with low-grade CS and in 15 ruptured fibrous caps and two erosions. Short-term outcomes, including the rate of internal shunt deployment under selective use based on intraoperative monitoring and new ischemic lesions after CEA on postoperative diffusion weighted images, as well as long term outcomes did not significantly differ between the groups. Conclusions: CEA was safe and effective for symptomatic low-grade CS that was refractory to aggressive medical treatment. Plaque characterization by MRI has the potential to provide more accurate stroke risk stratification for the management of low-grade CS.

scholarly journals Colocalization of Erythrocytes and Vascular Calcification in Human Atherosclerosis: A Systematic Histomorphometric Analysis

TH Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e113-e124
Author(s):  
Elsa Wilma Böhm ◽  
Maria Pavlaki ◽  
Georgios Chalikias ◽  
Dimitrios Mikroulis ◽  
George S. Georgiadis ◽  
...  
Keyword(s):  
Calcium Phosphate ◽  
Aortic Valve ◽  
Carotid Artery ◽  
Vascular Tissue ◽  
Osteoblastic Differentiation ◽  
Aortic Aneurysms ◽  
Vascular Lesions ◽  
Erythrocyte Membranes ◽  
Intraplaque Hemorrhage ◽  
Alizarin Red

Abstract Background Intimal calcification typically develops in advanced atherosclerosis, and microcalcification may promote plaque progression and instability. Conversely, intraplaque hemorrhage and erythrocyte extravasation may stimulate osteoblastic differentiation and intralesional calcium phosphate deposition. The presence of erythrocytes and their main cellular components (membranes, hemoglobin, and iron) and colocalization with calcification has never been systematically studied. Methods and Results We examined three types of diseased vascular tissue specimens, namely, degenerative aortic valve stenosis (n = 46), atherosclerotic carotid artery plaques (n = 9), and abdominal aortic aneurysms (n = 14). Biomaterial was obtained from symptomatic patients undergoing elective aortic valve replacement, carotid artery endatherectomy, or aortic aneurysm repair, respectively. Serial sections were stained using Masson–Goldner trichrome, Alizarin red S, and Perl's iron stain to visualize erythrocytes, extracelluar matrix and osteoid, calcium phosphate deposition, or the presence of iron and hemosiderin, respectively. Immunohistochemistry was employed to detect erythrocyte membranes (CD235a), hemoglobin or the hemoglobin scavenger receptor (CD163), endothelial cells (CD31), myofibroblasts (SMA), mesenchymal cells (osteopontin), or osteoblasts (periostin). Our analyses revealed a varying degree of intraplaque hemorrhage and that the majority of extravasated erythrocytes were lysed. Osteoid and calcifications also were frequently present, and erythrocyte membranes were significantly more prevalent in areas with calcification. Areas with extravasated erythrocytes frequently contained CD163-positive cells, although calcification also occurred in areas without CD163 immunosignals. Conclusion Our findings underline the presence of extravasated erythrocytes and their membranes in different types of vascular lesions, and their association with areas of calcification suggests an active role of erythrocytes in vascular disease processes.

Validity of ultrasound arterial wall vascularization for assessment of vascular inflammation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W Sato ◽  
Y Kobayashi ◽  
M Otaka ◽  
M Unuma ◽  
T Yamanaka ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Predictive Value ◽  
Arterial Wall ◽  
Carotid Arteries ◽  
Vascular Inflammation ◽  
False Negative ◽  
Intraplaque Hemorrhage ◽  
Funding Source ◽  
Negative Finding ◽  
18F Fdg

Abstract Background Vascular inflammation plays a fundamental role in most vascular diseases including atherosclerosis and vasculitis syndrome, in which arterial wall vascularization (AWV) frequently develops. Visualization of AWV is informative in detecting the vascular inflammation but is challenging. A new ultrasound technique (superb micro-vascular imaging [SMI]) allows the detection of extremely low-velocity flows. We examined an availability of SMI for assessment of the instability of atherosclerotic plaques and the activity of Takayasu arteritis (TA). Methods and results The study consists of two independent and consecutive parts A and B, examined in carotid stenosis (A) and TA (B), respectively. In part A, 12 patients with symptomatic severe carotid stenosis (CS group) scheduled for carotid endarterectomy were enrolled. In six of 12 patients, preoperative ultrasonography with SMI showed intraplaque neovascularization at the plaque shoulder. Postoperatively, histopathology confirmed the neovessels at the corresponding sites of visualized AWV. SMI had a sensitivity of 67%, specificity of 90% for detection of AWV in CS group. In SMI analysis, false positive findings were caused by motion artifact and arterial wall calcification, and a false negative finding is attributed by intraplaque hemorrhage. In part B, 10 patients with TA were enrolled. All patients underwent 18F-FDG-PET/CT, and its vascular uptake were compared with AWV detected by SMI. Bilateral common carotid arteries (CCA), internal carotid arteries and common iliac arteries were examined by SMI. Active vascular 18F-FDG uptake (max SUV &gt;2.1) were found at five sites in three patients, which were not significantly correlated with the prevalence of macaroni sign, increase in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Of note, SMI revealed AWV at five sites corresponding to uptake of 18F-FDG, with a sensitivity/specificity of 100% and 98%, positive predictive value 71%, and a negative predictive value 100%. Conclusion SMI enables visualization of AWV at vulnerable plaque in CS patients and at 18F-FDG positive sites in TA patients. SMI has potential as a modality to detect the vascular inflammation. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Grant-in-Aid for Scientific Research, Japan

scholarly journals A Switch from Cell-Associated to Soluble PDGF-B Protects against Atherosclerosis, despite Driving Extramedullary Hematopoiesis

Cells ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 1746
Author(s):  
Renée J. H. A. Tillie ◽  
Thomas L. Theelen ◽  
Kim van Kuijk ◽  
Lieve Temmerman ◽  
Jenny de Bruijn ◽  
...  
Keyword(s):  
Microvessel Density ◽  
Body Weight Gain ◽  
Oxidized Ldl ◽  
Mesenchymal Cell ◽  
Extramedullary Hematopoiesis ◽  
Collagen Content ◽  
Metabolic Effects ◽  
Intraplaque Hemorrhage ◽  
High Cholesterol Diet ◽  
Genetic Ablation

Platelet-derived growth factor B (PDGF-B) is a mitogenic, migratory and survival factor. Cell-associated PDGF-B recruits stabilizing pericytes towards blood vessels through retention in extracellular matrix. We hypothesized that the genetic ablation of cell-associated PDGF-B by retention motif deletion would reduce the local availability of PDGF-B, resulting in microvascular pericyte loss, microvascular permeability and exacerbated atherosclerosis. Therefore, Ldlr-/-Pdgfbret/ret mice were fed a high cholesterol diet. Although plaque size was increased in the aortic root of Pdgfbret/ret mice, microvessel density and intraplaque hemorrhage were unexpectedly unaffected. Plaque macrophage content was reduced, which is likely attributable to increased apoptosis, as judged by increased TUNEL+ cells in Pdgfbret/ret plaques (2.1-fold) and increased Pdgfbret/ret macrophage apoptosis upon 7-ketocholesterol or oxidized LDL incubation in vitro. Moreover, Pdgfbret/ret plaque collagen content increased independent of mesenchymal cell density. The decreased macrophage matrix metalloproteinase activity could partly explain Pdgfbret/ret collagen content. In addition to the beneficial vascular effects, we observed reduced body weight gain related to smaller fat deposition in Pdgfbret/ret liver and adipose tissue. While dampening plaque inflammation, Pdgfbret/ret paradoxically induced systemic leukocytosis. The increased incorporation of 5-ethynyl-2′-deoxyuridine indicated increased extramedullary hematopoiesis and the increased proliferation of circulating leukocytes. We concluded that Pdgfbret/ret confers vascular and metabolic effects, which appeared to be protective against diet-induced cardiovascular burden. These effects were unrelated to arterial mesenchymal cell content or adventitial microvessel density and leakage. In contrast, the deletion drives splenic hematopoiesis and subsequent leukocytosis in hypercholesterolemia.

The clinical and pathological features of intraplaque hemorrhage in coronary artery -insights from Japan DCA registry-

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Nakamura ◽  
S Torii ◽  
T Ijichi ◽  
K Jujo ◽  
M Hara ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Unstable Angina ◽  
De Novo ◽  
Coronary Intervention ◽  
Coronary Plaque ◽  
Active Cell ◽  
Intraplaque Hemorrhage ◽  
Histopathological Analysis ◽  
Coronary Syndrome ◽  
Clinical Presentations

Abstract Introduction Intraplaque hemorrhage (IPH) is known to play an important role in plaque vulnerability in coronary artery. However, the biological reaction in IPH and clinical features of patients with IPH remain unknown, since most histological studies of IPH in coronary artery were performed on autopsy cases. Directional coronary atherectomy (DCA) enables the direct pathological evaluation of collected tissue from “living” patients. Purpose We aimed to clarify the clinical presentations and histopathologic features of IPH using specimens obtained by DCA. Method This multicentral prospective observational study included consecutive patients who underwent percutaneous coronary intervention for de novo lesions using DCA from June 2015 to February 2018. Histopathological sections that were collected from coronary plaques by DCA were evaluated and classified by the presence of IPH. IPH in DCA specimens was defined as clusters of hemosiderin (Figure A, arrows), erythrocytes (Figure B, arrow heads) and fibrin (Figure C, arrows) within the coronary plaque. A total of 154 de novo lesions from 154 patients were ultimately analyzed, and were divided into IPH group (n=37) and non-IPH group (n=117). Result Clinical profiles of patients in the two groups were comparable, except that unstable angina rather than chronic coronary syndrome was significantly more prevalent in the IPH group (32.4% vs. 16.2%, P=0.04). Histopathological analysis showed a significantly higher incidence of cellular-rich plaque (46.0% vs. 25.6%, P=0.02) and spindle-shaped cells (18.9% vs. 6.0%, P=0.02), which indicate active cell proliferations, in the IPH group. The prevalence of necrotic core was also higher in IPH group compared to non-IPH group (48.7% vs. 13.7%, P&lt;0.01). Conclusion Pathohistological analysis revealed that coronary plaques with IPH had an active cell proliferation, and patients with IPH likely to had clinical presentations of unstable angina. Figure 1 Funding Acknowledgement Type of funding source: None

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