Superficial and multiple calcifications and ulceration associate with intraplaque hemorrhage in the carotid atherosclerotic plaque.
Woolf, Adam K
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Yang, J., Pan, X., Zhang, B., Yan, Y., Huang, Y., Woolf, A. K., Gillard, J., et al. (2018). Superficial and multiple calcifications and ulceration associate with intraplaque hemorrhage in the carotid atherosclerotic plaque.. European radiology, 28 (12), 4968-4977. https://doi.org/10.1007/s00330-018-5535-7
Objective: Intraplaque hemorrhage (IPH) and ulceration of carotid atherosclerotic plaques have been associated with vulnerability while calcification was conventionally thought protective. However, studies suggested calcification size and location may increase plaque vulnerability. This study explored the association between calcium configurations and ulceration with IPH. Methods: 137 consecutive symptomatic patients scheduled for CEA were recruited. CTA and CTP were performed prior to surgery. Plaque samples were collected for histology. According to the location, calcifications were categorized into superficial, deep and mixed types; and according to the size and number, calcifications were classified as thick and thin, multiple and single. Results: 71 plaques had IPH and 83 had ulceration. The appearance of IPH and ulceration was correlated (r=0.49; p<0.001). The incidence of multiple, superficial and thin calcifications were significantly higher in lesions with IPH and ulceration compared to those without. After adjusting factors including age, stenosis and ulceration, the presence of calcification (OR (95% CI), 3.0 (1.1-8.2), p=0.035), multiple calcification (3.9 (1.4-10.9), p=0.009), and superficial calcification (3.4 (1.1-10.8), p=0.001) were all associated with IPH. ROC analysis showed that the AUC of superficial and multiple calcifications in detecting IPH was 0.63 and 0.66, respectively (p<0.05). When the ulceration was combined, AUC increased significantly to 0.82 and 0.83, respectively. Results also showed that patients with lesions of both ulceration and IPH have significantly reduced brain perfusion in the area ipsilateral to infarction. Conclusions: Superficial and multiple calcifications and ulceration were associated with carotid IPH and they may be a surrogate for higher risk lesions.
Carotid Arteries, Humans, Carotid Stenosis, Calcinosis, Hemorrhage, Endarterectomy, Carotid, ROC Curve, Aged, Female, Male, Plaque, Atherosclerotic, Computed Tomography Angiography
NIHR Cambridge Biomedical Research Centre
External DOI: https://doi.org/10.1007/s00330-018-5535-7
This record's URL: https://www.repository.cam.ac.uk/handle/1810/279364
Attribution 4.0 International (CC BY 4.0)
Licence URL: https://creativecommons.org/licenses/by/4.0/