| Purpose:This study aimed to systematically investigate the characteristics,etiology,risk factors and predictive value of carotid plaque progression using multi-contrast magnetic resonance imaging(MRI):To evaluate the segment-specific progression of atherosclerotic carotid plaques,to investigate the association between shape and location of atherosclerotic plaques and intraplaque hemorrhage(IPH)in carotid arteries,to investigate the risk factors of carotid plaque progression,and to investigate the association between carotid plaque progression and subsequent recurrent events.Methods:① Symptomatic patients with recent cerebral ischemic symptoms who had atherosclerosis with 30%-69%stenosis in at least one side of carotid artery determined by ultrasound were recruited in this study.All the patients underwent MR vessel wall imaging for bilateral carotid arteries at baseline and follow-up time point(≥6 months after baseline).According to the location of the maximum wall thickness of carotid arteries,carotid plaques were divided into two categories of plaques above bifurcation and ones below bifurcation.The progression of plaques located above and below bifurcation of carotid artery was compared.② Symptomatic patients who underwent MR imaging and had advanced carotid plaques were included in analysis.Presence of IPH,shape(Type-I,Type-Ⅱ and Type-Ⅲ)and location(below and above bifurcation)of carotid plaques were evaluated.The plaque shape and location were compared between plaques with and without IPH and their associations with IPH were determined.③Symptomatic patients who had carotid atherosclerosis with 30%-69%stenosis were enrolled in this study.Carotid MRI was performed at baseline and follow-up time point(≥6 months after baseline),respectively.The characteristics of carotid plaque progression among different age groups(>75years old,60～75 years old and<60 years old)were compared.④Symptomatic patientswith ipsilateral carotid atherosclerotic stenosis(30-69%stenosis)determined by ultrasound underwent first and second carotid artery MR imaging for carotid artery at baseline and>6 months after first scan,respectively.All the patients were clinically followed-up after the second MR scan for<5 years until the onset of recurrent transient ischemia attack(TIA)or stroke.Results:①96 carotid plaques in 73 patients were eligible for statistical analysis.Compared with plaques located below bifurcation of carotid arteries,ones located above bifurcation had significantly greater stenosis at baseline(P=0.016)and greater progression rate of carotid wall volume(P=0.026).In patients with plaques located above the bifurcation of carotid arteries,logistic regression showed that age(OR,1.1;95%CI,1.01-1.14;P=0.019),hypertension(OR,5.4;95%CI,1.28-23.06;P=0.022)and smoke(OR,9.4;95%CI,1.08-81.79;P=0.042)were significantly associated with the annual change of carotid wall volume.In patients with plaques located below the bifurcation of carotid arteries,logistic regression showed that only age(OR,1.1;95%CI,1.00-1.16;P=0.032)was significantly associated with the annual change of carotid wall volume.②Of 181 detected plaques,57(31.5%)had IPH.Compared with plaques without IPH,those with IPH had higher incidence of shape of type-Ⅰ(P<0.001),lower incidence of shape of type-Ⅲ(P=0.001)and were more likely located above carotid bifurcation(P=0.003).The shape of type-Ⅰ(OR,4.01;95%CI,1.36-11.83;P=0.012)and location above bifurcation(OR,3.21;95%CI,1.07-9.61;P=0.037)of carotid plaques were significantly associated with IPH after adjusted for confounder factors.③Seventy-three patients with 96 plaques were included in the final analysis.Compared with younger patients,older ones had significantly higher incidence of calcification in carotid plaques(P=0.013),greater annual change of carotid wall volume(P=0.032)and maximum carotid wall area(P=0.046).Age(OR,1.44;95%CI,1.10-1.89;P=0.009)and hypertension(OR,4.61;95%CI,1.41-15.02;P=0.011)were independent predictors in discriminating upper quartile of annual change of carotid wall volume after adjusting for all clinical factors.④ Sixty-three patients were eligible for final statistics analysis.Over a mean follow-up duration of55.1±13.6months,14.3%of patients(n=9)experienced ipsilateral recurrent TIA/stroke.The annual progression of carotid wall volume wassignificantly associated with recurrent events before(HR:1.14 per 10mm3;95%CI=1.02-1.27;P=0.019)and after(HR=1.19 per 10mm3;95%CI=1.03-1.37;P=0.022)adjusted for confounding factors.In discriminating the recurrence of TIA/stroke,ROC analysis indicated that combined with annual progression of wall volume,there was a significant incremental improvement in the AUC of IPH(AUC:0.69 to 0.81)and FCR(AUC:0.73 to 0.84).Conclusions:Plaques located above the bifurcation of carotid arteries had greater annual progression than plaques below the bifurcation of carotid artery.Plaques located above the bifurcation had more IPH which may contribute to the different progression of plaques located above and below bifurcation,and the shape of plaques was also associated with the incidence of carotid IPH.Age and hypertension were significantly associated with carotid plaque progression and mignt be risk factors of carotid plaque progression.The annual progression of carotid wall volume could predict the recurrence of ischemic cerebrovascular events and the predictive value improved when combined with plaque features including IPH and FCR at baseline. |
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