title: Association between carotid artery plaque ulceration and plaque composition evaluated with multidetector CT angiography.
abstract: OBJECTIVE
  Symptomatic carotid artery plaque ulceration is associated with distinct plaque components such as a large lipid-rich necrotic core (LR-NC) in ischemic stroke patients with a ≥50% carotid stenosis. We evaluated the associations between carotid artery plaque ulceration and plaque characteristics in ischemic stroke patients with ≥50% stenosis, as well as in those with a low degree of stenosis (0% to 49%).
  
  
  METHODS
  Consecutive patients (n=346) with symptoms in the anterior circulation were evaluated with multidetector CT angiography (MDCTA) for the presence of atherosclerotic plaque, degree of stenosis, and plaque ulceration in the symptomatic carotid artery. Plaque volume and plaque component proportions of LR-NC, fibrous tissue, and calcification were measured. The associations between plaque ulceration and plaque characteristics were analyzed using logistic regression.
  
  
  RESULTS
  Atherosclerotic plaque was present in 185 patients. Plaque ulcerations were present in 38 (21%) patients, of which half had a low degree stenosis (0% to 49%). Plaque volume was significantly larger in ulcerated plaques. After adjustment for age, sex, and degree of stenosis, LR-NC proportion was strongly associated with plaque ulceration (odds ratio, 2.21; 95% CI, 1.49 to 3.27), whereas calcification proportion was inversely associated with plaque ulceration (odds ratio, 0.60; 95% CI, 0.40 to 0.89). These associations remained significant in patients with a low degree stenosis (0% to 49%).
  
  
  CONCLUSIONS
  Plaque volume, degree of stenosis, and LR-NC proportion evaluated noninvasively with MDCTA are associated with carotid artery plaque ulceration, even in patients with a low degree stenosis (0% to 49%). Plaque volume and composition analysis with MDCTA may identify rupture prone plaques and improve risk stratification in ischemic stroke patients.
authors.affiliation: Department of Radiology, Erasmus MC, University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Homburg
authors.forename: Sietske
authors.initials: S
authors.lastname: Rozie
authors.forename: Marjon J
authors.initials: MJ
authors.lastname: van Gils
authors.forename: Quirijn J A
authors.initials: QJ
authors.lastname: van den Bouwhuijsen
authors.forename: Wiro J
authors.initials: WJ
authors.lastname: Niessen
authors.forename: Diederik W J
authors.initials: DW
authors.lastname: Dippel
authors.forename: Aad
authors.initials: A
authors.lastname: van der Lugt
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000379:methods / Q000592:standards; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries / Q000592:standards; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000592:standards*