Carotid Intraplaque Hemorrhage: MRI of Therapeutic Response and Clinical Sequelae

描述（由申请人提供）：根据自然史研究，颈动脉粥样硬化病变中的斑块内出血（IPH）与斑块负荷增长加速和未来卒中发生风险增加相关。虽然有明确的迹象表明，严重的后遗症，随后的IPH在颈动脉，药物治疗的影响IPH和真正的神经影响IPH仍然是不确定的。本项目的总体目标是确定积极的药物治疗是否能改变IPH患者颈动脉粥样硬化疾病的自然病程。该建议的中心假设是，尽管他汀类药物治疗和积极的血压调节，IPH的颈动脉病变是不可恢复的损害相比，颈动脉病变没有IPH。由于IPH在颈动脉狭窄的所有级别都已被认识到，因此确定药物治疗的益处（如果有的话）是目前颈动脉粥样硬化疾病知识中的一个关键空白。此外，尽管进行了积极的药物治疗，但神经系统缺血（无症状或明显）增加的识别可能会大大改变所有狭窄水平IPH患者的管理。 公共卫生相关性：尽管有关动脉粥样硬化的研究正在进行并且知识不断增加，但心脏病和中风仍然分别是美国第一和第三大死亡原因。该提案旨在通过定量MRI技术的发展和研究的性能来研究颈动脉斑块内出血（动脉粥样硬化斑块的一个组成部分）背后的机制，以监测当前药物治疗对斑块内出血患者的有效性。这可能会导致改善这些患者的诊断和药物治疗，以及动脉粥样硬化研究的新技术。

DESCRIPTION (provided by applicant): From natural history studies, intraplaque hemorrhage (IPH) in the carotid atherosclerotic lesion has been associated with an acceleration of plaque burden growth and an increased risk of future stroke development. While there are clear indications of the critical sequelae consequent of IPH in the carotids, effects of medical therapy on IPH and the true neurological impact of IPH remain undetermined. The overall goal of this project is to determine if aggressive medical therapy alters the natural history of carotid atherosclerotic disease in patients with IPH. The central hypothesis of this proposal is that despite statin therapy and aggressive regulation of blood pressure, carotid lesions with IPH are irrecoverably compromised compared to carotid lesions without IPH. Since IPH has been recognized at all levels of carotid stenosis, the identification of benefits, if any, from medical therapy is a critical gap in the current knowledge of carotid atherosclerotic disease. Moreover, the identification of increased neurological ischemia (silent or overt) despite aggressive medical therapy may substantially alter the management in patients with IPH across all levels of stenosis. PUBLIC HEALTH RELEVANCE: Despite ongoing research and increasing knowledge about atherosclerosis, heart disease and stroke remain the first and third leading causes of death, respectively, in the United States. This proposal seeks to investigate the mechanisms behind intraplaque hemorrhage-a component of atherosclerotic plaque- in the carotid artery by development of quantitative MRI techniques and the performance of a study to monitor the effectiveness of current medical therapies on patients with intraplaque hemorrhage. This may lead to improved diagnoses and medical therapies for these patients, as well as new techniques for the study of atherosclerosis.