Magnetic resonance angiography detection of abnormal carotid artery plaque in patients with cryptogenic stroke.

TitleMagnetic resonance angiography detection of abnormal carotid artery plaque in patients with cryptogenic stroke.
Publication TypeJournal Article
Year of Publication2015
AuthorsGupta A, Gialdini G, Lerario MP, Baradaran H, Giambrone A, Navi BB, Marshall RS, Iadecola C, Kamel H
JournalJ Am Heart Assoc
Date Published2015 Jun 15
KeywordsAged, Aged, 80 and over, Carotid Arteries, Carotid Stenosis, Female, Humans, Magnetic Resonance Angiography, Male, Stroke

BACKGROUND: Magnetic resonance imaging of carotid plaque can aid in stroke risk stratification in patients with carotid stenosis. However, the prevalence of complicated carotid plaque in patients with cryptogenic stroke is uncertain, especially as assessed by plaque imaging techniques routinely included in acute stroke magnetic resonance imaging protocols. We assessed whether the magnetic resonance angiography-defined presence of intraplaque high-intensity signal (IHIS), a marker of intraplaque hemorrhage, is associated with ipsilateral cryptogenic stroke.

METHODS AND RESULTS: Cryptogenic stroke patients with magnetic resonance imaging evidence of unilateral anterior circulation infarction and without hemodynamically significant (≥50%) stenosis of the cervical carotid artery were identified from a prospective stroke registry at a tertiary-care hospital. High-risk plaque was assessed by evaluating for IHIS on routine magnetic resonance angiography source images using a validated technique. To compare the presence of IHIS on the ipsilateral versus contralateral side within individual patients, we used McNemar's test for correlated proportions. A total of 54 carotid arteries in 27 unique patients were included. A total of 6 patients (22.2%) had IHIS-positive nonstenosing carotid plaque ipsilateral to the side of ischemic stroke compared to 0 patients who had IHIS-positive carotid plaques contralateral to the side of stroke (P=0.01). Stroke severity measures, diagnostic evaluations, and prevalence of vascular risk factors were not different between the IHIS-positive and IHIS-negative groups.

CONCLUSIONS: Our findings suggest that a proportion of strokes classified as cryptogenic may be mechanistically related to complicated, nonhemodynamically significant cervical carotid artery plaque that can easily be detected by routine magnetic resonance imaging/magnetic resonance angiography acute stroke protocols.

Alternate JournalJ Am Heart Assoc
PubMed ID26077590
PubMed Central IDPMC4599540
Grant ListK23 NS082367 / NS / NINDS NIH HHS / United States
R01 NS034179 / NS / NINDS NIH HHS / United States
K23NS082367 / NS / NINDS NIH HHS / United States