title: Asymptomatic moderate carotid artery stenosis with intraplaque hemorrhage: onset of new ischemic stroke.
abstract: BACKGROUND
  The degree of stenosis of carotid arteries is recognized as an important risk factor for ischemic stroke. However, high-grade stenosis does not always cause cerebrovascular events, whereas low- to moderate-grade stenosis may often cause strokes. It has been reported that there is an association between carotid intraplaque hemorrhage (IPH) and new brain ischemic events.
  
  
  METHODS
  We present three patients with asymptomatic moderate carotid artery stenosis and carotid IPH who underwent both neurological and MRI at baseline and after at least 1 year's follow-up. These patients were admitted to our hospital (after 15-35 months of follow-up) because of neurological deficits. Diffusion-weighted MRI of the brain showed ipsilateral new ischemic lesions due to carotid artery plaques. The patients were treated with carotid artery stenting and discharged uneventfully.
  
  
  CONCLUSIONS
  Whether plaques with severe stenosis already had severe stenosis at the onset of events or plaques with moderate stenosis progressed owing to an acute change, such as growth of an IPH, remains unclear, because no carotid imaging was carried out just before the events. This is the first case report which presents neurological symptoms and MRI at both baseline and follow-up in patients with asymptomatic moderate carotid artery stenosis and carotid IPH.
authors.affiliation: Department of Neurosurgery, Sato Daiichi Hospital, Oita, Japan.
authors.forename: Kiyofumi
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Kawasaki
authors.affiliation: Department of Neurosurgery, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yoshimura
authors.affiliation: Department of Neurosurgery, Sato Daiichi Hospital, Oita, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sasaki
authors.affiliation: Department of Neurosurgery, Sato Daiichi Hospital, Oita, Japan.
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Nakahara
authors.affiliation: Department of Radiology, Sato Daiichi Hospital, Oita, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Sato
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D002545:Brain Ischemia / Q000175:diagnosis* / Q000209:etiology; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology
keywords: MRI; Stenosis; Stent; Stroke