Carotid plaque hemorrhage on magnetic resonance imaging strongly predicts recurrent ischemia and stroke.
Carotid plaque hemorrhage on magnetic resonance imaging strongly predicts recurrent ischemia and stroke.
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DOI：
10.1002/ana.23876
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发表时间：
2013-06
影响因子：
11.2
通讯作者：
Auer, Dorothee P.
中科院分区：
文献类型：
--
作者：
Hosseini, Akram A.;Kandiyil, Neghal;MacSweeney, Shane T. S.;Altaf, Nishath;Auer, Dorothee P.
有一个公认的需要，以改善选择颈动脉狭窄的患者颈动脉内膜切除术（CEA）。我们评估了磁共振成像（MRI）定义的颈动脉斑块出血（MRIPH）预测症状性颈动脉狭窄患者复发性同侧脑缺血事件和卒中的价值。前瞻性招募了179例狭窄≥50%的症状性患者，进行颈动脉MRI，并进行临床随访，直至CEA、死亡或缺血事件。如果斑块信号强度大于邻近肌肉的150%，则诊断为MRIPH。使用Kaplan-Meier图和考克斯回归模型进行无事件生存分析，控制已知的血管风险因素。我们还对MRIPH和复发事件的报告数据进行了荟萃分析。114例患者（63.7%）显示MRIPH，92%（57/62）的同侧复发事件和除1例（25/26）外的所有未来卒中。未经MRIPH的患者估计每年绝对中风风险仅为0.6%。考克斯多变量回归分析证明MRIPH是复发性缺血事件（风险比[HR] = 12.0，95%置信区间[CI] = 4.8-30.1，p < 0.001）和单独卒中（HR = 35.0，95% CI = 4.7-261.6，p = 0.001）的强预测因子。对已发表数据的荟萃分析证实了MRIPH与症状性颈动脉狭窄患者复发性脑缺血事件之间的相关性（比值比= 12.2，95% CI = 5.5-27.1，p < 0.00001）。在症状性颈动脉狭窄≥50%的患者中，MRIPH可独立且强烈预测复发性同侧缺血事件和单独卒中。没有MRIPH的患者卒中风险非常低，这对目前CEA在该亚组中的风险-获益评估提出了质疑。神经网络2013;73：774-784
There is a recognized need to improve selection of patients with carotid artery stenosis for carotid endarterectomy (CEA). We assessed the value of magnetic resonance imaging (MRI)-defined carotid plaque hemorrhage (MRIPH) to predict recurrent ipsilateral cerebral ischemic events, and stroke in symptomatic carotid stenosis. One hundred seventy-nine symptomatic patients with ≥50% stenosis were prospectively recruited, underwent carotid MRI, and were clinically followed up until CEA, death, or ischemic event. MRIPH was diagnosed if the plaque signal intensity was >150% that of the adjacent muscle. Event-free survival analysis was done using Kaplan–Meier plots and Cox regression models controlling for known vascular risk factors. We also undertook a meta-analysis of reported data on MRIPH and recurrent events. One hundred fourteen patients (63.7%) showed MRIPH, suffering 92% (57 of 62) of all recurrent ipsilateral events and all but 1 (25 of 26) future strokes. Patients without MRIPH had an estimated annual absolute stroke risk of only 0.6%. Cox multivariate regression analysis proved MRIPH as a strong predictor of recurrent ischemic events (hazard ratio [HR] = 12.0, 95% confidence interval [CI] = 4.8–30.1, p < 0.001) and stroke alone (HR = 35.0, 95% CI = 4.7–261.6, p = 0.001). Meta-analysis of published data confirmed this association between MRIPH and recurrent cerebral ischemic events in symptomatic carotid artery stenosis (odds ratio = 12.2, 95% CI = 5.5–27.1, p < 0.00001). MRIPH independently and strongly predicts recurrent ipsilateral ischemic events, and stroke alone, in symptomatic ≥50% carotid artery stenosis. The very low stroke risk in patients without MRIPH puts into question current risk–benefit assessment for CEA in this subgroup. ANN NEUROL 2013;73:774–784
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DOI：
10.1056/nejmoa0912321
发表时间：
2010-07-01
期刊：
The New England journal of medicine
影响因子：
--
作者：
Brott TG;Hobson RW 2nd;Howard G;Roubin GS;Clark WM;Brooks W;Mackey A;Hill MD;Leimgruber PP;Sheffet AJ;Howard VJ;Moore WS;Voeks JH;Hopkins LN;Cutlip DE;Cohen DJ;Popma JJ;Ferguson RD;Cohen SN;Blackshear JL;Silver FL;Mohr JP;Lal BK;Meschia JF;CREST Investigators
通讯作者：
CREST Investigators
DOI：
10.3174/ajnr.a2213
发表时间：
2010-09
期刊：
AJNR. American journal of neuroradiology
影响因子：
--
作者：
Demarco JK;Ota H;Underhill HR;Zhu DC;Reeves MJ;Potchen MJ;Majid A;Collar A;Talsma JA;Potru S;Oikawa M;Dong L;Zhao X;Yarnykh VL;Yuan C
通讯作者：
Yuan C
影响因子：
8.3
作者：
Altaf, Nishath;MacSweeney, Shane T.;Auer, Dorothee P.
通讯作者：
Auer, Dorothee P.
影响因子：
8.3
作者：
McCabe, DJH;Pereira, AC;Brown, MM
通讯作者：
Brown, MM
影响因子：
19.7
作者：
Altaf, Nishath;Goode, Stephen D.;Auer, Dorothee P.
通讯作者：
Auer, Dorothee P.