title: Intraplaque Hemorrhage and the Plaque Surface in Carotid Atherosclerosis: The Plaque At RISK Study (PARISK).
abstract: OBJECTIVE
  An important characteristic of vulnerable plaque, intraplaque hemorrhage, may predict plaque rupture. Plaque rupture can be visible on noninvasive imaging as a disruption of the plaque surface. We investigated the association between intraplaque hemorrhage and disruption of the plaque surface.
  
  
  METHODS
  We selected the first 100 patients of the Plaque At RISK study, an ongoing prospective noninvasive plaque imaging study in patients with mild-to-moderate atherosclerotic lesions in the carotid artery. In carotid artery plaques, disruption of the plaque surface (defined as ulcerated plaques and/or fissured fibrous cap) and intraplaque hemorrhage were assessed by using MDCTA and 3T MR imaging, respectively. We used a χ(2) test and multivariable logistic regression to assess the association between intraplaque hemorrhage and disrupted plaque surface.
  
  
  RESULTS
  One hundred forty-nine carotid arteries in 78 patients could be used for the current analyses. Intraplaque hemorrhage and plaque ulcerations were more prevalent in symptomatic compared with contralateral vessels (hemorrhage, 38% versus 11%; P < .001; and ulcerations, 27% versus 7%; P = .001). Fissured fibrous cap was more prevalent in symptomatic compared with contralateral vessels (13% versus 4%; P = .06). After adjustment for age, sex, diabetes mellitus, and degree of stenosis, intraplaque hemorrhage was associated with disrupted plaque surface (OR, 3.13; 95% CI, 1.25-7.84) in all vessels.
  
  
  CONCLUSIONS
  Intraplaque hemorrhage is associated with disruption of the plaque surface in patients with a carotid artery stenosis of <70%. Serial studies are needed to investigate whether intraplaque hemorrhage indeed increases the risk of plaque rupture and subsequent ischemic stroke during follow-up.
authors.affiliation: From the Departments of Radiology (A.C.v.D., B.H., T.Z.,G.S., A.v.d.L.) Neurology (A.C.v.D., P.J.K.).
authors.forename: A C
authors.initials: AC
authors.lastname: van Dijk
authors.affiliation: Departments of Radiology (M.T.B.T., M.E.K.) Clinical Neurophysiology (M.T.B.T.) Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases (M.T.B.T., M.E.K.), Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: M T B
authors.initials: MT
authors.lastname: Truijman
authors.affiliation: From the Departments of Radiology (A.C.v.D., B.H., T.Z.,G.S., A.v.d.L.).
authors.forename: B
authors.initials: B
authors.lastname: Hussain
authors.affiliation: From the Departments of Radiology (A.C.v.D., B.H., T.Z.,G.S., A.v.d.L.).
authors.forename: T
authors.initials: T
authors.lastname: Zadi
authors.affiliation: From the Departments of Radiology (A.C.v.D., B.H., T.Z.,G.S., A.v.d.L.).
authors.forename: G
authors.initials: G
authors.lastname: Saiedie
authors.affiliation: Department of Radiology (A.A.J.d.R., J.H.), University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: A A J
authors.initials: AA
authors.lastname: de Rotte
authors.affiliation: Departments of Neurology (M.I.L., P.J.N.).
authors.forename: M I
authors.initials: MI
authors.lastname: Liem
authors.affiliation: Biomedical Engineering (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: A F W
authors.initials: AF
authors.lastname: van der Steen
authors.affiliation: Pathology (M.J.A.P.D.), Amsterdam Medical Center, Amsterdam, the Netherlands.
authors.forename: M J A P
authors.initials: MJ
authors.lastname: Daemen
authors.affiliation: Neurology (A.C.v.D., P.J.K.).
authors.forename: P J
authors.initials: PJ
authors.lastname: Koudstaal
authors.affiliation: Departments of Neurology (M.I.L., P.J.N.).
authors.forename: P J
authors.initials: PJ
authors.lastname: Nederkoorn
authors.affiliation: Department of Radiology (A.A.J.d.R., J.H.), University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Hendrikse
authors.affiliation: Departments of Radiology (M.T.B.T., M.E.K.) Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases (M.T.B.T., M.E.K.), Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: M E
authors.identifier: http://orcid.org/0000-0001-7562-5724
authors.initials: ME
authors.lastname: Kooi
authors.affiliation: From the Departments of Radiology (A.C.v.D., B.H., T.Z.,G.S., A.v.d.L.) a.vanderlugt@erasmusmc.nl.
authors.forename: A
authors.initials: A
authors.lastname: van der Lugt
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000473:pathology; D016893:Carotid Stenosis / Q000473:pathology*; D003952:Diagnostic Imaging; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000473:pathology*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology