title: Prediction of high-risk plaque development and plaque progression with the carotid atherosclerosis score.
abstract: OBJECTIVE
  The goal of this prospective study was to evaluate the carotid atherosclerosis score (CAS) for predicting the development of high-risk plaque features and plaque burden progression.
  
  
  BACKGROUND
  Previous studies have shown that carotid intraplaque hemorrhage (IPH) and a disrupted luminal surface (DLS), as identified by using magnetic resonance imaging, are associated with greater risk for cerebrovascular events. On the basis of data from a large cross-sectional study, a scoring system was developed to determine which plaque features are associated with the presence of IPH and DLS. However, the predictive value of CAS has not been previously tested in a prospective, longitudinal study.
  
  
  METHODS
  A total of 120 asymptomatic subjects with 50% to 79% carotid stenosis underwent carotid magnetic resonance imaging scans at baseline and 3 years thereafter. Presence of IPH and DLS, wall volume, maximum wall thickness, and maximum percent lipid-rich necrotic core area were measured at both time-points. Baseline CAS values were calculated on the basis of previously published criteria.
  
  
  RESULTS
  Of the 73 subjects without IPH or DLS at baseline, 9 (12%) developed 1 or both of these features during follow-up. There was a significant increasing trend between CAS and the development of new DLS (p < 0.001) and with plaque burden progression (p = 0.03) but not with the development of new IPH (p = 0.3). Percent carotid stenosis was not significantly associated with new DLS (p = 0.2), new IPH (p = 0.1), or plaque progression (p = 0.6).
  
  
  CONCLUSIONS
  CAS was found to have a significant increasing relationship with incident DLS and plaque progression in this prospective study. CAS can potentially provide improved risk stratification beyond luminal stenosis.
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: Dongxiang
authors.initials: D
authors.lastname: Xu
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Hippe
authors.affiliation: Departments of Neurological Surgery and Medicine, University of Washington, Seattle, Washington.
authors.forename: Hunter R
authors.initials: HR
authors.lastname: Underhill
authors.affiliation: Department of Radiology, Tohoku University, Sendai, Japan.
authors.forename: Minako
authors.initials: M
authors.lastname: Oikawa-Wakayama
authors.affiliation: Department of Radiology, Anzhen Hospital, Beijing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Dong
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: Kiyofumi
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: Chun
authors.initials: C
authors.lastname: Yuan
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington. Electronic address: tomhat@u.washington.edu.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Hatsukami
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D002339:Carotid Arteries / Q000473:pathology*; D016893:Carotid Stenosis / Q000453:epidemiology / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012422:Rupture, Spontaneous; D013997:Time Factors; D014861:Washington / Q000453:epidemiology
keywords: carotid atherosclerosis score; disrupted luminal surface; plaque progression; stenosis