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Research ArticleExtracranial Vascular

Carotid Intraplaque-Hemorrhage Volume and Its Association with Cerebrovascular Events

L. Saba, G. Micheletti, W. Brinjikji, P. Garofalo, R. Montisci, A. Balestrieri, J.S. Suri, J.K. DeMarco, G. Lanzino and R. Sanfilippo
American Journal of Neuroradiology October 2019, 40 (10) 1731-1737; DOI: https://doi.org/10.3174/ajnr.A6189
L. Saba
aFrom the Departments of Radiology (L.S., G.M., P.G., A.B.)
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G. Micheletti
aFrom the Departments of Radiology (L.S., G.M., P.G., A.B.)
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W. Brinjikji
cDepartments of Radiology (W.B.)
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P. Garofalo
aFrom the Departments of Radiology (L.S., G.M., P.G., A.B.)
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R. Montisci
bVascular Surgery (R.M., R.S.), Azienda Ospedaliero Universitaria, Monserrato (Cagliari), Italy
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A. Balestrieri
aFrom the Departments of Radiology (L.S., G.M., P.G., A.B.)
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J.S. Suri
eStroke Monitoring and Diagnostic Division (J.S.S.), AtheroPoint, Roseville, California
fPoint-of-Care Devices (J.S.S.), Global Biomedical Technologies, Roseville, California
gDepartment of Electrical Engineering (J.S.S.), University of Idaho, Moscow, Idaho (Affiliated)
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J.K. DeMarco
hDepartment of Radiology (J.K.D.), Walter Reed Medical Center, Bethesda, Maryland.
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G. Lanzino
dNeurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota
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R. Sanfilippo
bVascular Surgery (R.M., R.S.), Azienda Ospedaliero Universitaria, Monserrato (Cagliari), Italy
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    Fig 1.

    The first case is a 69-year-old male patient with right stroke who underwent CTA that showed a large IPH component of 107 mm3 (A–C). A, The coronal view of the carotid CTA is given with the segmentation of the software (white open arrow). B, A coronal cut of the postprocessed carotid arteries is shown (white arrowhead). C, The white arrow indicates the internal carotid artery in the axial selected section. The legend of the chromatic scale is the following: red = IPH; yellow = lipid-IPH component; blue = mixed component; green = calcified component. The second case is a 73-year-old male patient with left MCA stroke with an IPH/lipid ratio of 0.93 (D–F). D–F, Three axial slices from the bifurcation upward were selected showing the presence of a large IPH and the small amount of lipid-IPH (white arrowheads).

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    Fig 2.

    Boxplot of the volume components of the carotid artery plaque according to the presence or absence of cerebral symptoms (A) and boxplot of the percentages of the components according to the presence or absence of cerebrovascular symptoms (B).

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    Fig 3.

    ROC curve analysis of the volume components of the carotid artery plaque according to the presence or absence of cerebral symptoms (A) and ROC curve analysis of the percentages of the components according to the presence or absence of cerebral symptoms (B).

Tables

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    Table 1:

    Demographic and plaque characteristic summary table

    Cerebrovascular SymptomsYesNoP ValueTest
    Demographics
        Age (mean) (95% CI) (yr)70 (66–74)68 (65–71).37Paired Student t
        Sex (male = 93)80% (37/46)74% (57/77).55χ2
        Hypertension26% (12/46)27% (42/154).98χ2
        CAD50% (23/46)45% (70/154).71χ2
        Smoking status43% (20/46)30% (46/154).12χ2
        Diabetes7% (3/43)7% (11/154).85χ2
        Dyslipidemia28% (13/46)32% (49/154).79χ2
    Plaque composition
        Total plaque volume (mm3)793 (565–984)560 (503–669).105Mann-Whitney
        Lipid volume (mm3)187 (132–240)79 (63–101).002aMann-Whitney
        Mixed volume (mm3)471 (400–544)318 (290–367).062Mann-Whitney
        Calcified volume (mm3)103 (70–150)128 (109–156).16Mann-Whitney
        IPH volume (mm3)115 (74–160)2 (0–9).001aMann-Whitney
        Lipid-IPH volume (mm3)61 (37–110)67 (60–87).14Mann-Whitney
        % of lipid23 (21–30)17 (14–18).002aMann-Whitney
        % of mixed58 (56–63)59 (56–61).51Mann-Whitney
        % of calcium13 (12–17)21 (18–22).001aMann-Whitney
        % of IPH15 (12–18)1 (0–3).001aMann-Whitney
        % of lipid-IPH8 (6–11)13 (12–14).001aMann-Whitney
        IPH/lipid ratio0.69 (0.59–0.73)0.019 (0–0.064).001aMann-Whitney
    • Note:—CAD indicates coronary artery disease.

    • ↵a Significant.

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    Table 2:

    ROC curve analysis between symptoms and volume/percentage of plaque tissues

    AUCSE95% CIP Value
    Plaque volume0.5790.0490.507–0.648.108
    IPH volume0.7930.04210.730–0.847.001
    Lipid minus IPH0.5740.04860.502–0.643.129
    Lipid volume0.6480.04860.577–0.714.002
    Mixed volume0.5940.04650.523–0.663.043
    Calcium volume0.5680.05170.497–0.638.186
    % of lipid0.6790.04760.609–0.743.001
    % of mixed0.5320.04590.460–0.602.489
    % of calcium0.5910.04260.522–0.654.135
    % of IPH0.8120.04130.751–0.863.001
    % of lipid minus IPH0.7020.04280.633–0.764.001
    IPH/lipid radio0.8110.04240.751–0.863.001
    • Note:—SE indicates standard error.

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    Table 3:

    χ2 test between symptoms and different volume thresholds of IPH

    χ2Contingency CoefficientP Value
    IPH, 10 mm312.5270.243.001
    IPH, 50 mm343.9130.424.001
    IPH, 100 mm337.4780.397.001
    IPH, 150 mm334.7630.385.001
    IPH, 200 mm314.9350.264.001
    IPH, 250 mm37.9440.195.048
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Cite this article
L. Saba, G. Micheletti, W. Brinjikji, P. Garofalo, R. Montisci, A. Balestrieri, J.S. Suri, J.K. DeMarco, G. Lanzino, R. Sanfilippo
Carotid Intraplaque-Hemorrhage Volume and Its Association with Cerebrovascular Events
American Journal of Neuroradiology Oct 2019, 40 (10) 1731-1737; DOI: 10.3174/ajnr.A6189

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Carotid Intraplaque-Hemorrhage Volume and Its Association with Cerebrovascular Events
L. Saba, G. Micheletti, W. Brinjikji, P. Garofalo, R. Montisci, A. Balestrieri, J.S. Suri, J.K. DeMarco, G. Lanzino, R. Sanfilippo
American Journal of Neuroradiology Oct 2019, 40 (10) 1731-1737; DOI: 10.3174/ajnr.A6189
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