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Research ArticleExtracranial Vascular
Open Access

Plaque Composition as a Predictor of Plaque Ulceration in Carotid Artery Atherosclerosis: The Plaque At RISK Study

K. Dilba, D.H.K. van Dam-Nolen, A.C. van Dijk, M. Kassem, A.F.W. van der Steen, P.J. Koudstaal, P.J. Nederkoorn, J. Hendrikse, M.E. Kooi, J.J. Wentzel and A. van der Lugt
American Journal of Neuroradiology January 2021, 42 (1) 144-151; DOI: https://doi.org/10.3174/ajnr.A6868
K. Dilba
aFrom the Departments of Radiology and Nuclear Medicine (K.D., D.H.K.v.D.-N., A.C.v.D., A.v.d.L.)
bCardiology (K.D., A.F.W.v.d.S., J.J.W.)
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  • ORCID record for K. Dilba
D.H.K. van Dam-Nolen
aFrom the Departments of Radiology and Nuclear Medicine (K.D., D.H.K.v.D.-N., A.C.v.D., A.v.d.L.)
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A.C. van Dijk
aFrom the Departments of Radiology and Nuclear Medicine (K.D., D.H.K.v.D.-N., A.C.v.D., A.v.d.L.)
cNeurology (A.C.v.D., P.J.K.), Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
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M. Kassem
dDepartment of Radiology and Nuclear Medicine (M.K., M.E.K.), CARIM School for Cardiovascular Diseases, Maastricht University Medical Center+, Maastricht, the Netherlands
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A.F.W. van der Steen
bCardiology (K.D., A.F.W.v.d.S., J.J.W.)
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P.J. Koudstaal
cNeurology (A.C.v.D., P.J.K.), Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
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P.J. Nederkoorn
eDepartment of Neurology (P.J.N.), University Medical Center Amsterdam, Amsterdam, the Netherlands
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J. Hendrikse
fDepartment of Radiology (J.H.), University Medical Center Utrecht, Utrecht, the Netherlands
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M.E. Kooi
dDepartment of Radiology and Nuclear Medicine (M.K., M.E.K.), CARIM School for Cardiovascular Diseases, Maastricht University Medical Center+, Maastricht, the Netherlands
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J.J. Wentzel
bCardiology (K.D., A.F.W.v.d.S., J.J.W.)
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A. van der Lugt
aFrom the Departments of Radiology and Nuclear Medicine (K.D., D.H.K.v.D.-N., A.C.v.D., A.v.d.L.)
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Abstract

BACKGROUND AND PURPOSE: Plaque ulceration is a marker of previous plaque rupture. We studied the association between atherosclerotic plaque composition at baseline and plaque ulceration at baseline and follow-up.

MATERIALS AND METHODS: We included symptomatic patients with a carotid stenosis of <70% who underwent MDCTA and MR imaging at baseline (n = 180). MDCTA was repeated at 2 years (n = 73). We assessed the presence of ulceration using MDCTA. Baseline MR imaging was used to assess the vessel wall volume and the presence and volume of plaque components (intraplaque hemorrhage, lipid-rich necrotic core, and calcifications) and the fibrous cap status. Associations at baseline were evaluated with binary logistic regression and reported with an OR and its 95% CI. Simple statistical testing was performed in the follow-up analysis.

RESULTS: At baseline, the prevalence of plaque ulceration was 27% (49/180). Increased wall volume (OR  = 12.1; 95% CI, 3.5–42.0), higher relative lipid-rich necrotic core (OR = 1.7; 95% CI, 1.3–2.2), higher relative intraplaque hemorrhage volume (OR = 1.7; 95% CI, 1.3–2.2), and a thin-or-ruptured fibrous cap (OR = 3.4; 95% CI, 1.7–6.7) were associated with the presence of ulcerations at baseline. In 8% (6/73) of the patients, a new ulcer developed. Plaques with a new ulceration at follow-up had at baseline a larger wall volume (1.04 cm3 [IQR, 0.97–1.16 cm3] versus 0.86 cm3 [IQR, 0.73–1.00 cm3]; P = .029), a larger relative lipid-rich necrotic core volume (23% [IQR, 13–31%] versus 2% [IQR, 0–14%]; P = .002), and a larger relative intraplaque hemorrhage volume (14% [IQR, 8–24%] versus 0% [IQR, 0–5%]; P < .001).

CONCLUSIONS: Large atherosclerotic plaques and plaques with intraplaque hemorrhage and lipid-rich necrotic cores were associated with plaque ulcerations at baseline and follow-up.

ABBREVIATIONS:

AUC
area under the curve
IPH
intraplaque hemorrhage
IQR
interquartile range
LRNC
lipid-rich necrotic core
TRFC
thick versus thin-or-ruptured fibrous cap
  • © 2021 by American Journal of Neuroradiology

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American Journal of Neuroradiology: 42 (1)
American Journal of Neuroradiology
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Plaque Composition as a Predictor of Plaque Ulceration in Carotid Artery Atherosclerosis: The Plaque At RISK Study
K. Dilba, D.H.K. van Dam-Nolen, A.C. van Dijk, M. Kassem, A.F.W. van der Steen, P.J. Koudstaal, P.J. Nederkoorn, J. Hendrikse, M.E. Kooi, J.J. Wentzel, A. van der Lugt
American Journal of Neuroradiology Jan 2021, 42 (1) 144-151; DOI: 10.3174/ajnr.A6868

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Plaque Composition as a Predictor of Plaque Ulceration in Carotid Artery Atherosclerosis: The Plaque At RISK Study
K. Dilba, D.H.K. van Dam-Nolen, A.C. van Dijk, M. Kassem, A.F.W. van der Steen, P.J. Koudstaal, P.J. Nederkoorn, J. Hendrikse, M.E. Kooi, J.J. Wentzel, A. van der Lugt
American Journal of Neuroradiology Jan 2021, 42 (1) 144-151; DOI: 10.3174/ajnr.A6868
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