title: Intraplaque hemorrhage, fibrous cap status, and microembolic signals in symptomatic patients with mild to moderate carotid artery stenosis: the Plaque at RISK study.
abstract: OBJECTIVE
  In patients with mild to moderate symptomatic carotid artery stenosis, intraplaque hemorrhage (IPH) and a thin/ruptured fibrous cap (FC) as evaluated with MRI, and the presence of microembolic signals (MESs) as detected with transcranial Doppler, are associated with an increased risk of a (recurrent) stroke. The objective of the present study is to determine whether the prevalence of MES differs in patients with and without IPH and thin/ruptured FC, and patients with only a thin/ruptured FC without IPH.
  
  
  METHODS
  In this multicenter, diagnostic cohort study, patients with recent transient ischemic attack or minor stroke in the carotid territory and an ipsilateral mild to moderate carotid artery plaque were included. IPH and FC status were dichotomously scored. Analysis of transcranial Doppler data was done blinded for the MRI results. Differences between groups were analyzed with Fisher exact test.
  
  
  RESULTS
  A total of 113 patients were included. Transcranial Doppler measurements were feasible in 105 patients (average recording time, 219 minutes). A total of 26 MESs were detected in 8 of 105 patients. In 44 of 105 plaques IPH was present. In 92 of 105 plaques FC status was assessable, 36 of these had a thin/ruptured FC. No significant difference in the prevalence of MES between patients with and without IPH (P=0.46) or with thick versus thin/ruptured FC (P=0.48) was found.
  
  
  CONCLUSIONS
  In patients with a symptomatic mild to moderate carotid artery stenosis, IPH and FC status are not associated with MES. This suggests that MRI and transcranial Doppler provide different information on plaque vulnerability.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT01709045.
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Martine T B
authors.initials: MT
authors.lastname: Truijman
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Alexandra A J
authors.initials: AA
authors.lastname: de Rotte
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Rune
authors.initials: R
authors.lastname: Aaslid
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Anouk C
authors.initials: AC
authors.lastname: van Dijk
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jeire
authors.initials: J
authors.lastname: Steinbuch
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Madieke I
authors.initials: MI
authors.lastname: Liem
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Floris H B M
authors.initials: FH
authors.lastname: Schreuder
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Anton F W
authors.initials: AF
authors.lastname: van der Steen
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Mat J A P
authors.initials: MJ
authors.lastname: Daemen
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: van Oostenbrugge
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Wildberger
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nederkoorn
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hendrikse
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Aad
authors.initials: A
authors.lastname: van der Lugt
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marianne Eline
authors.initials: ME
authors.lastname: Kooi
authors.affiliation: From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands (J.S.); Departments of Neurology (M.I.L., P.J.N.) and Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, The Netherlands. werner.mess@mumc.nl.
authors.forename: Werner H
authors.initials: WH
authors.lastname: Mess
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000175:diagnosis* / Q000453:epidemiology; D016037:Single-Blind Method
keywords: magnetic resonance imaging; plaque, atherosclerotic; transcranial Doppler sonography