Co-existing cerebrovascular atherosclerosis predicts subsequent vascular event: a multi-contrast cardiovascular magnetic resonance imaging study

J Cardiovasc Magn Reson. 2020 Jan 13;22(1):4. doi: 10.1186/s12968-019-0596-6.

Abstract

Background: It is still unknown that whether co-existing intracranial stenosis and extracranial carotid vulnerable plaques have higher predictive value for subsequent vascular events. This study aimed to determine the relationship between co-existing extracranial carotid vulnerable plaques and intracranial stenosis and subsequent vascular events utilizing cardiovascular magnetic resonance (CMR) vessel wall imaging.

Methods: Patients who had recent cerebrovascular symptoms in anterior circulation (< 2 weeks) were consecutively enrolled and underwent multi-contrast CMR vessel wall imaging for extracranial carotid arteries and 3D time-of flight CMR angiography for intracranial arteries at baseline. After baseline examination, all patients were followed-up for at least 1 year to determined recurrence of vascular events. The co-existing cerebrovascular atherosclerosis was defined as presence of both intracranial artery stenosis and at least one the following measures of extracranial artery atherosclerosis: plaque, calcification, lipid-rich necrotic core (LRNC), or intraplaque hemorrhage. Univariate and multivariate Cox regressions were used to calculate the hazard ratio (HR) and corresponding 95% confidence interval (CI) of co-existing plaques in predicting subsequent vascular events.

Results: In total, 150 patients (mean age: 61.8 ± 11.9 years; 109 males) were recruited. During the median follow-up time of 12.1 months, 41 (27.3%) patients experienced vascular events. Co-existing intracranial artery stenosis and extracranial carotid plaque (HR, 3.57; 95% CI, 1.63-7.82; P = 0.001) and co-existing intracranial artery stenosis and extracranial carotid LRNC (HR, 4.47; 95% CI, 2.15-9.27; P < 0.001) were significantly associated with subsequent vascular events, respectively. After adjusted for confounding factors and carotid stenosis, these associations remained statistically significant (HR, 5.12; 95% CI, 1.36-19.24; P = 0.016 and HR, 8.12; 95% CI, 2.41-27.31; P = 0.001, respectively).

Conclusions: The co-existing cerebrovascular atherosclerotic diseases, particularly co-existing carotid lipid-rich necrotic core and intracranial stenosis, are independent predictors for subsequent vascular events.

Keywords: Acute coronary syndrome; Atherosclerosis; Cardiovascular magnetic resonance imaging; Cerebrovascular; Stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / diagnostic imaging
  • Acute Coronary Syndrome / etiology*
  • Aged
  • Carotid Stenosis / complications
  • Carotid Stenosis / diagnostic imaging*
  • Cerebral Angiography*
  • Female
  • Humans
  • Intracranial Arteriosclerosis / complications
  • Intracranial Arteriosclerosis / diagnostic imaging*
  • Ischemic Attack, Transient / diagnostic imaging
  • Ischemic Attack, Transient / etiology*
  • Magnetic Resonance Angiography*
  • Male
  • Middle Aged
  • Plaque, Atherosclerotic*
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Rupture, Spontaneous
  • Stroke / diagnosis
  • Stroke / etiology*
  • Time Factors