title: Relationship between watershed infarcts and recent intra plaque haemorrhage in carotid atherosclerotic plaque.
abstract: OBJECTIVE
  Watershed infarcts (WSI) are thought to result from hemodynamic mechanism, but studies have suggested that microemboli from unstable carotid plaques may distribute preferentially in watershed areas, i.e., between two cerebral arterial territories. Intraplaque haemorrhage (IPH) is an emerging marker of plaque instability and microembolic activity. We assessed the association between WSI and IPH in patients with recently symptomatic moderate carotid stenosis.
  
  
  RESULTS
  We selected 65 patients with symptomatic moderate (median NASCET degree of stenosis = 31%) carotid stenosis and brain infarct on Diffusion-Weighted Imaging (DWI) on Magnetic Resonance Imaging (MRI) from a multicentre prospective study. Fourteen (22%) had WSI (cortical, n = 8; internal, n = 4; cortical and internal, n = 2). Patients with WSI were more likely to have IPH than those without WSI although the difference was not significant (50% vs. 31%, OR = 2.19; 95% CI, 0.66-7.29; P = 0.20). After adjustment for degree of stenosis, age and gender, the results remained unchanged.
  
  
  CONCLUSIONS
  About one in fifth of brain infarcts occurring in patients with moderate carotid stenosis were distributed in watershed areas. Albeit not significant, an association between IPH--more generally plaque component--and WSI, still remains possible.
authors.affiliation: Université Paris Descartes, Service de Neurologie, Inserm U894, Paris, France.
authors.forename: Clothilde
authors.initials: C
authors.lastname: Isabel
authors.affiliation: Université Paris Descartes, Service de Neuroradiologie, Inserm U894, Paris, France.
authors.forename: Augustin
authors.initials: A
authors.lastname: Lecler
authors.affiliation: Université Paris Descartes, Service de Neurologie, Inserm U894, Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Turc
authors.affiliation: Université Paris Descartes, Service de Neuroradiologie, Inserm U894, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Naggara
authors.affiliation: Service de Neurologie, CHRU Nancy, Nancy, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Schmitt
authors.affiliation: Service de neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Samia
authors.initials: S
authors.lastname: Belkacem
authors.affiliation: Université Paris Descartes, Service de Neuroradiologie, Inserm U894, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Oppenheim
authors.affiliation: Université Paris Descartes, Service de Neurologie, Inserm U894, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Touzé
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000473:pathology*; D002339:Carotid Arteries / Q000473:pathology*; D016893:Carotid Stenosis / Q000473:pathology*; D005260:Female; D006470:Hemorrhage / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000473:pathology*; D020521:Stroke / Q000473:pathology*