title: Co-existing intracranial and extracranial carotid artery atherosclerotic plaques and recurrent stroke risk: a three-dimensional multicontrast cardiovascular magnetic resonance study.
abstract: BACKGROUND
  As a systemic disease, atherosclerosis commonly affects intracranial and extracranial carotid arteries simultaneously which is defined as co-existing plaques. Previous studies demonstrated that co-existing atherosclerotic diseases are significantly associated with ischemic cerebrovascular events. The aim of this study was to investigate the characteristics of co-existing intracranial and extracranial carotid atherosclerotic plaques and their relationships with recurrent stroke by using 3D multi-contrast magnetic resonance (MR) vessel wall imaging.
  
  
  METHODS
  Patients with recent cerebrovascular symptoms in anterior circulation and at least one carotid plaque were recruited. All patients underwent cardiovascular magnetic resonance (CMR) for brain and intracranial and extracranial arteries. Presence/absence of atherosclerotic plaque at each arterial segment was identified. The maximum wall thickness (Max WT), length, stenosis of each plaque was measured. The presence/absence of calcification, lipid-rich necrotic core (LRNC), and intraplaque hemorrhage (IPH) was assessed. Cerebral old and acute infarcts in anterior circulation were evaluated.
  
  
  RESULTS
  Fifty-eight patients (mean age: 58.0 ± 8.5 years old, 34 males) were recruited. Of the 58 patients, co-existing intracranial and extracranial carotid artery plaques were found in 45 patients (77.6%), of which 7 (15.6%) had first time acute stroke and 26 (57.8%) had recurrent stroke. For these 33 patients with stroke, the number of intracranial plaques (OR = 11.26; 95% CI, 1.27-100; p = 0.030) and co-existing intracranial and extracranial carotid artery plaques (OR = 2.42; 95% CI, 1.04-5.64; p = 0.040) was significantly associated with recurrent stroke. After adjusting for traditional risk factors, the number of co-existing plaques was still significantly correlated with recurrent stroke (OR = 3.31; 95% CI, 1.09-10.08; p = 0.035). No correlations were found between recurrent stroke and Max WT, length, stenosis, and compositions of plaques.
  
  
  CONCLUSIONS
  Co-existing intracranial and extracranial carotid artery plaques are prevalent in symptomatic patients and the number of co-existing plaques is independently associated with the risk of recurrent stroke.
authors.affiliation: Department of Radiology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
authors.forename: Yilan
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.|Department of Radiology, University of Washington, Seattle, WA, USA.
authors.forename: Chun
authors.initials: C
authors.lastname: Yuan
authors.affiliation: Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.
authors.forename: Zechen
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.
authors.forename: Le
authors.initials: L
authors.lastname: He
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Donghua
authors.initials: D
authors.lastname: Mi
authors.affiliation: Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Li
authors.affiliation: Department of Radiology, PLA General Hospital, Beijing, China.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
authors.forename: Yilong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
authors.forename: Gaifen
authors.initials: G
authors.lastname: Liu
authors.affiliation: Department of Radiology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
authors.forename: Zhuozhao
authors.initials: Z
authors.lastname: Zheng
authors.affiliation: Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China. xihaizhao@tsinghua.edu.cn.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China. xihaizhao@tsinghua.edu.cn.|Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Haidian District, 100084, Beijing, China. xihaizhao@tsinghua.edu.cn.
authors.forename: Xihai
authors.initials: X
authors.lastname: Zhao
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002533:Cerebral Angiography / Q000379:methods*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D003287:Contrast Media / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016015:Logistic Models; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D016017:Odds Ratio; D010865:Pilot Projects; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology
chemical_list: D003287:Contrast Media
keywords: Atherosclerosis; Cardiovascular magnetic resonance; Carotid artery; Intracranial artery; Recurrent stroke