Carotid plaque hemorrhage on magnetic resonance imaging strongly predicts recurrent ischemia and stroke.
Bottom Line: Cox multivariate regression analysis proved MRIPH as a strong predictor of recurrent ischemic events (hazard ratio [HR] = 12.0, 95% confidence interval [CI] = 4.8-30.1, p < 0.001) and stroke alone (HR = 35.0, 95% CI = 4.7-261.6, p = 0.001).Meta-analysis of published data confirmed this association between MRIPH and recurrent cerebral ischemic events in symptomatic carotid artery stenosis (odds ratio = 12.2, 95% CI = 5.5-27.1, p < 0.00001).The very low stroke risk in patients without MRIPH puts into question current risk-benefit assessment for CEA in this subgroup.
Affiliation: Division of Radiological and Imaging Sciences, University of Nottingham, Queen's Medical Campus, Nottingham, United Kingdom.Show MeSH
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Mentions: Kaplan–Meier survival analysis demonstrated significantly shorter stroke-free survival for the MRIPH+ compared with MRIPH− group (overall chi-square = 28.3, df = 1, p < 0.001; Fig 2A). Univariate Cox regression analysis for stroke confirmed MRIPH to significantly increase the risk of future ipsilateral ischemic stroke (hazard ratio [HR] = 33.7, 95% confidence interval [CI] = 4.5–251.3, p = 0.001). Applying backward conditional modeling, adjusted for known vascular risk factors and time from indexed symptoms to MRI, revealed MRIPH as the only significant factor to predict recurrent stroke (HR = 35.0, 95% CI = 4.7–261.6, p = 0.001). Similarly, Kaplan–Meier survival analysis illustrated remarkably different survival curves of participants remaining free of all ipsilateral cerebral ischemic events between those with or without MRIPH (overall chi-square = 41.7, df = 1, p < 0.001; see Fig 2B).
Affiliation: Division of Radiological and Imaging Sciences, University of Nottingham, Queen's Medical Campus, Nottingham, United Kingdom.