title: Vasa vasorum enhancement on computerized tomographic angiography correlates with symptomatic patients with 50% to 70% carotid artery stenosis.
abstract: OBJECTIVE
  Significant stenosis of the internal carotid artery (ICA) is an established stroke risk factor. Recent evidence suggests that features within the atherosclerotic plaque also have prognostic value. The purpose of this study was to correlate the enhancement of the vasa vasorum (VV) overlying the carotid artery plaque with acute neurological symptoms in patients with 50% to 70% ICA stenosis.
  
  
  METHODS
  We conducted a 4-year retrospective computerized tomographic angiographic review to identify patients with 50% to 70% stenosis of the ICA. Three types of plaques were identified: enhancing VV, calcified, and nonenhancing-noncalcified. Medical records were reviewed for cardiovascular risk factors and neurological status, and imaging was reviewed for signs of a recent stroke.
  
  
  RESULTS
  We identified a total of 428 patients with 50% to 70% ICA stenosis: 103 (24.1%) had enhancing VV, 202 (47.2%) calcified, and 123 (28.7%) nonenhancing-noncalcified arteries; 97 were symptomatic and 331 asymptomatic. Thirty-three (34%) symptomatic subjects demonstrated enhancing VV, 42 (20%) had calcified arterial plaques, and 22 (17%) had nonenhancing-noncalcified arterial plaques. Fisher exact tests revealed that the proportion of symptomatic individuals with enhancing VV plaque was double that of the other groups combined (P=0.015; odds ratio, 1.92; 95% confidence interval, 1.17-3.16). Regression analyses confirmed this association as independent from other known cardiovascular risk factors.
  
  
  CONCLUSIONS
  In patients with 50% to 70% ICA stenosis, VV enhancement recognized on computed tomographic angiography is strongly associated with acute neurological symptoms compared with calcified and nonenhancing-noncalcified arterial plaques. This finding may aid in the identification of patients at increased risk for ischemic stroke within populations with the same degree of stenosis.
authors.affiliation: From the Departments of Radiology (J.M.R., R.P., W.A., A.M., C.J., R.G.G.), Surgery (G.L.), Cardiology (M.R.J.), and Neurology (F.B.), Massachusetts General Hospital, Harvard University, Boston; and Department of Interventional Neuroradiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, MN (J.D.A.).
authors.forename: Javier M
authors.initials: JM
authors.lastname: Romero
authors.forename: Raffaella
authors.initials: R
authors.lastname: Pizzolato
authors.forename: Wendy
authors.initials: W
authors.lastname: Atkinson
authors.forename: Anna
authors.initials: A
authors.lastname: Meader
authors.forename: Camilo
authors.initials: C
authors.lastname: Jaimes
authors.forename: Glenn
authors.initials: G
authors.lastname: Lamuraglia
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jaff
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Buonanno
authors.forename: Josser
authors.initials: J
authors.lastname: Delgado Almandoz
authors.forename: Ramon G
authors.initials: RG
authors.lastname: Gonzalez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014651:Vasa Vasorum / Q000000981:diagnostic imaging*
keywords: atherosclerosis; carotid artery diseases