Carotid Intraplaque Hemorrhage: MRI of Therapeutic Response and Clinical Sequelae

描述(由申请人提供)：从自然病史研究来看，颈动脉粥样硬化病变中的斑块内出血(IPH)与斑块负担增长加速和未来中风发展的风险增加有关。虽然有明确的迹象表明IPH对颈动脉的严重后遗症，但药物治疗对IPH的影响以及IPH对神经系统的真正影响仍不确定。该项目的总体目标是确定积极的药物治疗是否改变了IPH患者颈动脉粥样硬化性疾病的自然病史。这一建议的中心假设是，尽管他汀类药物治疗和积极调节血压，但与没有IPH的颈动脉病变相比，有IPH的颈动脉病变是不可恢复的。由于IPH在所有水平的颈动脉狭窄中都已被认识到，因此，确定药物治疗的益处(如果有的话)是目前对颈动脉粥样硬化性疾病的认识的一个关键空白。此外，尽管进行了积极的药物治疗，但发现增加的神经缺血(无症状或明显的)可能会显著改变所有程度狭窄的IPH患者的治疗。 公共卫生相关性：尽管对动脉粥样硬化的研究正在进行中，人们对动脉粥样硬化的了解也在不断增加，但心脏病和中风仍然分别是美国第一和第三大死亡原因。这项建议旨在通过开发定量MRI技术和一项监测斑块内出血患者当前药物治疗有效性的研究，来研究颈动脉斑块内出血--动脉粥样硬化斑块的一种成分--背后的机制。这可能会改善对这些患者的诊断和医疗治疗，以及研究动脉粥样硬化的新技术。

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.