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Cardiovascular magnetic resonance in carotid atherosclerotic disease.

Dong L, Kerwin WS, Ferguson MS, Li R, Wang J, Chen H, Canton G, Hatsukami TS, Yuan C - J Cardiovasc Magn Reson (2009)

Bottom Line: Atherosclerosis is a chronic, progressive, inflammatory disease affecting many vascular beds.Disease progression leads to acute cardiovascular events such as myocardial infarction, stroke and death.Advances in carotid vessel wall CMR allow comprehensive assessment of morphology inside the wall, contributing substantial disease-specific information beyond luminal stenosis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiology, University of Washington, Seattle, WA, USA. lido2@u.washington.edu

ABSTRACT
Atherosclerosis is a chronic, progressive, inflammatory disease affecting many vascular beds. Disease progression leads to acute cardiovascular events such as myocardial infarction, stroke and death. The diseased carotid alone is responsible for one third of the 700,000 new or recurrent strokes occurring yearly in the United States. Imaging plays an important role in the management of atherosclerosis, and cardiovascular magnetic resonance (CMR) of the carotid vessel wall is one promising modality in the evaluation of patients with carotid atherosclerotic disease. Advances in carotid vessel wall CMR allow comprehensive assessment of morphology inside the wall, contributing substantial disease-specific information beyond luminal stenosis. Although carotid vessel wall CMR has not been widely used to screen for carotid atherosclerotic disease, many trials support its potential for this indication. This review summarizes the current state of knowledge regarding carotid vessel wall CMR and its potential clinical application for management of carotid atherosclerotic disease.

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Related in: MedlinePlus

The Ruptured Carotid Plaque. A Movat's Pentachrome stain of a common carotid fibrous cap disruption. The disruption (big arrow) is framed by two branches of the fibrous cap (asterisks) on the right side, and a cap overlaid with thrombus on the left (small arrow). The chevron points to a region of organizing thrombus. (Magnification 100×, inset 10×)
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Figure 1: The Ruptured Carotid Plaque. A Movat's Pentachrome stain of a common carotid fibrous cap disruption. The disruption (big arrow) is framed by two branches of the fibrous cap (asterisks) on the right side, and a cap overlaid with thrombus on the left (small arrow). The chevron points to a region of organizing thrombus. (Magnification 100×, inset 10×)

Mentions: For CMR, the most important clinical question to be answered for patients with established carotid lesions is whether the lesion poses a high, near-term risk for complications. Retrospective histological studies of carotid atherosclerotic lesions implicated in ischemic stroke and transient ischemic attacks have found those lesions to exhibit plaque disruption, most commonly fibrous cap rupture (Figure 1). Spagnoli et al. reported ipsilateral fibrous cap rupture was observed in 66.7% (64/96) of patients with major stroke, 23.1% (21/91) of patients with transient ischemic attack, and only 13.4% (11/82) of patients without prior ischemic symptoms [30]. Similarly, Carr et al. found that cap rupture occurred more frequently in symptomatic patients (74%) than in asymptomatic patients (32%) [31]. Once an atherosclerotic plaque is disrupted, the thrombogenic contents and lipid core are exposed to platelets and coagulation factors in circulating blood, predisposing the patient to an acute thromboembolic event. The study by Spagnoli et al. found that an acute thrombus was associated with cap rupture in 90.1% (64/71) patients with stroke. The clinical significance of plaque disruption begs the question whether CMR can visualize cap rupture. Of note, fibrous cap rupture and thrombosis can also occur in the carotid artery without overt clinical symptoms. Prior sites of rupture and thrombus can act as further stimuli for thrombus development. Thus, identification of these features on carotid vessel wall CMR could be an important part of a risk reduction strategy of stroke.


Cardiovascular magnetic resonance in carotid atherosclerotic disease.

Dong L, Kerwin WS, Ferguson MS, Li R, Wang J, Chen H, Canton G, Hatsukami TS, Yuan C - J Cardiovasc Magn Reson (2009)

The Ruptured Carotid Plaque. A Movat's Pentachrome stain of a common carotid fibrous cap disruption. The disruption (big arrow) is framed by two branches of the fibrous cap (asterisks) on the right side, and a cap overlaid with thrombus on the left (small arrow). The chevron points to a region of organizing thrombus. (Magnification 100×, inset 10×)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2806867&req=5

Figure 1: The Ruptured Carotid Plaque. A Movat's Pentachrome stain of a common carotid fibrous cap disruption. The disruption (big arrow) is framed by two branches of the fibrous cap (asterisks) on the right side, and a cap overlaid with thrombus on the left (small arrow). The chevron points to a region of organizing thrombus. (Magnification 100×, inset 10×)
Mentions: For CMR, the most important clinical question to be answered for patients with established carotid lesions is whether the lesion poses a high, near-term risk for complications. Retrospective histological studies of carotid atherosclerotic lesions implicated in ischemic stroke and transient ischemic attacks have found those lesions to exhibit plaque disruption, most commonly fibrous cap rupture (Figure 1). Spagnoli et al. reported ipsilateral fibrous cap rupture was observed in 66.7% (64/96) of patients with major stroke, 23.1% (21/91) of patients with transient ischemic attack, and only 13.4% (11/82) of patients without prior ischemic symptoms [30]. Similarly, Carr et al. found that cap rupture occurred more frequently in symptomatic patients (74%) than in asymptomatic patients (32%) [31]. Once an atherosclerotic plaque is disrupted, the thrombogenic contents and lipid core are exposed to platelets and coagulation factors in circulating blood, predisposing the patient to an acute thromboembolic event. The study by Spagnoli et al. found that an acute thrombus was associated with cap rupture in 90.1% (64/71) patients with stroke. The clinical significance of plaque disruption begs the question whether CMR can visualize cap rupture. Of note, fibrous cap rupture and thrombosis can also occur in the carotid artery without overt clinical symptoms. Prior sites of rupture and thrombus can act as further stimuli for thrombus development. Thus, identification of these features on carotid vessel wall CMR could be an important part of a risk reduction strategy of stroke.

Bottom Line: Atherosclerosis is a chronic, progressive, inflammatory disease affecting many vascular beds.Disease progression leads to acute cardiovascular events such as myocardial infarction, stroke and death.Advances in carotid vessel wall CMR allow comprehensive assessment of morphology inside the wall, contributing substantial disease-specific information beyond luminal stenosis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiology, University of Washington, Seattle, WA, USA. lido2@u.washington.edu

ABSTRACT
Atherosclerosis is a chronic, progressive, inflammatory disease affecting many vascular beds. Disease progression leads to acute cardiovascular events such as myocardial infarction, stroke and death. The diseased carotid alone is responsible for one third of the 700,000 new or recurrent strokes occurring yearly in the United States. Imaging plays an important role in the management of atherosclerosis, and cardiovascular magnetic resonance (CMR) of the carotid vessel wall is one promising modality in the evaluation of patients with carotid atherosclerotic disease. Advances in carotid vessel wall CMR allow comprehensive assessment of morphology inside the wall, contributing substantial disease-specific information beyond luminal stenosis. Although carotid vessel wall CMR has not been widely used to screen for carotid atherosclerotic disease, many trials support its potential for this indication. This review summarizes the current state of knowledge regarding carotid vessel wall CMR and its potential clinical application for management of carotid atherosclerotic disease.

Show MeSH
Related in: MedlinePlus