Advertisement







Click here for more guidelines.
CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 2008; 51:1014-1021, doi:10.1016/j.jacc.2007.10.054
© 2008 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Saam, T.
Right arrow Articles by Hatsukami, T. S.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Saam, T.
Right arrow Articles by Hatsukami, T. S.

CLINICAL RESEARCH: CARDIAC IMAGING

Prevalence of American Heart Association Type VI Carotid Atherosclerotic Lesions Identified by Magnetic Resonance Imaging for Different Levels of Stenosis as Measured by Duplex Ultrasound

Tobias Saam, MD*,{dagger}, Hunter R. Underhill, MD{dagger}, Baocheng Chu, MD, PhD{dagger}, Norihide Takaya, MD, PhD{dagger}, Jianming Cai, MD, PhD{dagger}, Nayak L. Polissar, PhD{ddagger}, Chun Yuan, PhD{dagger} and Thomas S. Hatsukami, MD§,*

* Department of Clinical Radiology, University of Munich, Grosshadern Campus, Munich, Germany
{dagger} Department of Radiology, University of Washington, Seattle, Washington
{ddagger} The Mountain-Whisper-Light Statistical Consulting, Seattle, Washington
§ VA Puget Sound Health Care System and Department of Surgery, University of Washington, Seattle, Washington.

Manuscript received July 5, 2007; revised manuscript received August 30, 2007, accepted October 15, 2007.

* Reprint requests and correspondence: Dr. Thomas S. Hatsukami, VA Puget Sound Health Care System, Surgery and Perioperative Care (112), 1660 South Columbian Way, Seattle, Washington 98108. (Email: tomhat{at}u.washington.edu).

Objectives: Via magnetic resonance imaging (MRI), we sought to determine the prevalence of atherosclerotic American Heart Association type VI lesions (AHA-LT6) (lesions with luminal surface defect, hemorrhage/thrombus, or calcified nodule) in carotid arteries that represented all categories of stenosis as measured by duplex ultrasound.

Background: Arterial stenosis alone has been shown to be a poor predictor of cardiovascular events. Autopsy studies suggest that features associated with AHA-LT6 lesions, rather than the degree of luminal narrowing, characterize the high-risk plaque.

Methods: A total of 192 subjects underwent bilateral carotid artery magnetic resonance imaging (MRI) scans at 1.5T after evaluation with ultrasound to determine stenosis. After excluding arteries with a previous endarterectomy, poor image quality, or missing ultrasound data, there were 175 patients with 260 arteries available for analysis. The AHA lesion type was determined by the consensus opinion of 2 experienced carotid MRI reviewers.

Results: In total, 96 of 260 (37.0%) arteries had ≥1 location with AHA-LT6. Of the arteries with AHA-LT6, 84.4% had hemorrhage, 45.8% had a ruptured fibrous cap, and 14.6% showed other type of complications. Prevalence of AHA-LT6 was an increasing sequence of 8.1% in the 37 arteries with 1% to 15% stenosis, 21.7% in the 60 arteries with 16% to 49% stenosis, 36.8% in the 114 arteries with 50% to 79% stenosis, and 77.6% in the 49 arteries with 80% to 99% stenosis.

Conclusions: Complicated AHA-LT6 are frequently found in arteries with ≤50% stenosis. These findings indicate that complex lesions develop in a substantial number of arteries in the absence of high-grade stenosis. Ongoing prospective studies will determine the predictive value of vulnerable plaque features, as visualized by MRI, for risk of subsequent ischemic events.

Abbreviations and Acronyms
  3D = 3-dimensional
  AHA = American Heart Association
  ImQ = image quality
  LT = lesion type
  MRI = magnetic resonance imaging
  NWI = normalized wall index
  PD = proton-density
  TOF = time-of-flight




This article has been cited by other articles:


Home page
HeartHome page
J E van Velzen, J D Schuijf, F R de Graaf, G Nucifora, G Pundziute, J W Jukema, M J Schalij, L J Kroft, A de Roos, J H C Reiber, et al.
Plaque type and composition as evaluated non-invasively by MSCT angiography and invasively by VH IVUS in relation to the degree of stenosis
Heart, December 15, 2009; 95(24): 1990 - 1996.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll Cardiol ImgHome page
M. J. Daemen and M. E. Kooi
Intraplaque Hemorrhage as a Stimulator of Episodic Growth of Advanced, But Nonsymptomatic Atherosclerotic Lesions: Bridging the Gap
J. Am. Coll. Cardiol. Img., December 1, 2009; 2(12): 1390 - 1392.
[Full Text] [PDF]


Home page
Eur Heart JHome page
C. M. Matter, M. Stuber, and M. Nahrendorf
Imaging of the unstable plaque: how far have we got?
Eur. Heart J., November 1, 2009; 30(21): 2566 - 2574.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
H. Ota, W. Yu, H. R. Underhill, M. Oikawa, L. Dong, X. Zhao, N. L. Polissar, B. Neradilek, T. Gao, Z. Zhang, et al.
Hemorrhage and Large Lipid-Rich Necrotic Cores Are Independently Associated With Thin or Ruptured Fibrous Caps: An In vivo 3T MRI Study
Arterioscler Thromb Vasc Biol, October 1, 2009; 29(10): 1696 - 1701.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll Cardiol ImgHome page
D. Li, Z. A. Fayad, and D. A. Bluemke
Can contrast-enhanced cardiac magnetic resonance assess inflammation of the coronary wall?
J. Am. Coll. Cardiol. Img., May 1, 2009; 2(5): 589 - 591.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
J. Sanz, P. R. Moreno, and V. Fuster
The Year in Atherothrombosis
J. Am. Coll. Cardiol., April 14, 2009; 53(15): 1326 - 1337.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
A. N. DeMaria, O. Ben-Yehuda, J. J. Bax, G. K. Feld, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, S. M. Narayan, D. J. Sahn, et al.
Highlights of the Year in JACC 2008.
J. Am. Coll. Cardiol., January 27, 2009; 53(4): 373 - 398.
[Full Text] [PDF]



 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement