Carotid Intraplaque Hemorrhage: MRI of Therapeutic Response and Clinical Sequelae

描述（由申请人提供）：从自然史研究来看，颈动脉粥样硬化病变斑块内出血（IPH）与斑块负担的加速生长和未来卒中发展的风险增加有关。虽然有明确的迹象表明IPH在颈动脉中有严重的后遗症，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会改变IPH患者颈动脉粥样硬化性疾病的自然史。该建议的中心假设是，尽管他汀类药物治疗和积极调节血压，与非IPH的颈动脉病变相比，IPH的颈动脉病变是不可恢复的。由于IPH已经在所有级别的颈动脉狭窄中得到认可，因此确定药物治疗的益处（如果有的话）是当前对颈动脉粥样硬化疾病知识的一个关键空白。此外，尽管进行了积极的药物治疗，但神经缺血（隐性或显性）增加的识别可能会大大改变所有程度狭窄的IPH患者的管理。

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.