title: Association between carotid atherosclerosis plaque with high signal intensity on T1-weighted imaging and subsequent ipsilateral ischemic events.
abstract: BACKGROUND
  An association between magnetic resonance imaging detection of intraplaque hemorrhage and the risk of cerebral ischemic events has been described. However, few studies have followed patients with intraplaque hemorrhage.
  
  
  OBJECTIVE
  We used 3-dimensional gradient-echo black-blood T1-weighted imaging (screening BB [S-BB]) as a magnetic resonance imaging sequence to evaluate acute cerebrovascular stroke. The association between S-BB high signal plaques and the risk of subsequent ipsilateral ischemic events was investigated.
  
  
  METHODS
  A total of 928 consecutive patients hospitalized for a stroke or transient ischemic attack according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification were evaluated. Recurrence was retrospectively evaluated in S-BB-positive patients and patients with severe stenosis (SS) (≥70%) by magnetic resonance angiography. Based on clinical and imaging findings, recurrence was defined as a carotid artery stroke or transient ischemic attack that developed after hospital discharge as an initial event.
  
  
  RESULTS
  Sixty-six patients were S-BB positive and 62 patients had severe stenosis (S-BB positive with SS, 32 patients; S-BB negative with SS, 30 patients; S-BB positive without SS, 34 patients). During a mean follow-up period of 9.1 months, 7 S-BB-positive patients with SS (18.7%) and 1 S-BB-negative patient with SS (3%) had a recurrent event (P = .051). In the S-BB-positive group, in 34 patients without SS, the recurrence rate was 14.7% (5/34); the difference in the recurrence rate between S-BB-positive group with and without SS was not significant (P = .34).
  
  
  CONCLUSIONS
  Patients with carotid artery lesions and intraplaque hemorrhage tend to be at higher risk of a subsequent ipsilateral ischemic event. Risk evaluation of carotid artery disease should include plaque characteristics.
authors.affiliation: Department of Neurosurgery, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan. kurosaki0106@gmail.com
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kurosaki
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Yoshida
authors.forename: Hideki
authors.initials: H
authors.lastname: Endo
authors.forename: Masaki
authors.initials: M
authors.lastname: Chin
authors.forename: Sen
authors.initials: S
authors.lastname: Yamagata
mesh_terms: D002545:Brain Ischemia / Q000453:epidemiology* / Q000209:etiology; D002340:Carotid Artery Diseases / Q000150:complications / Q000473:pathology*; D005260:Female; D006470:Hemorrhage / Q000150:complications / Q000473:pathology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000473:pathology*; D012008:Recurrence