Stroke Risk: Increased Risk with Intraplaque Carotid Artery Hemorrhage

Tobias Saam, MD Institute of Clinical Radiology Ludwig-Maximilians-Univ Hosp Munich, Interview with:
Tobias Saam, MD
Institute of Clinical Radiology
Ludwig-Maximilians-Univ Hosp
Munich, Germany What are the main findings of the study?

Dr. Saam: The results of our meta-analysis suggest that despite a large degree of detected heterogeneity of the published studies, the presence of intraplaque hemorrhage by MRI in patients with carotid artery disease is associated with an approximately 5.6-fold higher risk for cerebrovascular events, such as TIA or stroke, as compared to subjects without intraplaque hemorrhage. Were any of the findings unexpected?

Dr. Saam: Most of our findings were expected, as several previous studies have shown an association of carotid intraplaque hemorrhage with ischemic results. We confirmed theses previous studies and were able to provide more precisely risk estimates due to the effect that we were able to include data of 8 separate studies with almost 700 patients and 108 events. However, we were surprised that the annualized event rate in subjects with detectable IPH was really high in subjects with intraplaque hemorrhage compared to subjects without intraplaque hemorrhage (17.7% vs 2.4%). What should clinicians and patients take away from your report?

Dr. Saam: While this result does not necessarily justify the widespread clinical use of carotid MRI in patients it provides a strong rationale for larger clinical trials to determine whether specific MRI plaque findings in the carotid arteries might be able to risk stratify patients into those who benefit from conservative versus interventional therapy. Furthermore, we showed that symptomatic patients with carotid stenosis and IPH have a particularly high risk of a recurrent event and, as a consequence, might benefit from early interventions.  What recommendations do you have for future research as a result of this study?

Dr. Saam: We were not able to analyze the event rates of symptomatic patients with IPH and <50% stenosis, given the very limited data, although there is increasing evidence that such lesions might play a role in the pathogenesis of symptoms in patients with cryptogenic stroke. Several ongoing prospective MRI trials, such as the CAPIAS trial (Carotid Plaque Imaging in Acute Stroke, NCT01284933), are investigating the consequences of such lesions on the occurrence of cerebrovascular events in patients with acute ischemic stroke and without significant carotid artery stenosis.


Meta-Analysis and Systematic Review of the Predictive Value of Carotid Plaque Hemorrhage on Cerebrovascular Events by Magnetic Resonance Imaging 

Tobias Saam; Holger Hetterich; Verena Hoffmann; Chun Yuan; Marcus Treitl; Martin Dichgans; Holger Poppert; Maximilian Reiser; Fabian Bamberg

Abstract Session Title: Vascular Medicine (Noncoronary): Molecules, Mechanisms and Physiology

Abstract 12997:

Circulation. 2012; 126: A12997