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Carotid arterial intraplaque hemorrhage and calcification influences cerebral hemodynamics

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Abstract

We evaluated associations between cerebral blood flow (CBF) and histopathological features in atherosclerotic lesions of the internal carotid artery. Cerebrovascular reactivity (CVR) and CBF were measured in 72 patients with unilateral carotid artery stenosis who underwent Xe-CT before carotid endarterectomy. Collateral blood flow was estimated as stump pressure. Proportions of fibrous tissue, intraplaque hemorrhage (IPH), and calcification were pathologically compared with the entire plaque body. The Spearman’s rank test and stepwise multiple linear regression analysis revealed that the IPH rate significantly and negatively correlated with CBF, whereas the calcification rate positively correlated with CVR. One-way analysis of variance showed that IPH and the absence of calcification might confer a risk for CBF and CVR reduction. Thus, not only the stenosis rate but also the degree of IPH and calcification in carotid arterial plaque are notable risk factors for ischemic stroke.

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Authors and Affiliations

  1. Department of Neurosurgery, Chugoku Rousai Hospital, Tagaya 1-5-1, Hiro, Kure-shi, Hiroshima, 737-0193, Japan

    Naomi Hashimoto & Kanji Yamane

  2. Department of Neurosurgery, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan

    Seiji Hama & Kaoru Kurisu

Authors
  1. Naomi Hashimoto
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  2. Seiji Hama
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  3. Kanji Yamane
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  4. Kaoru Kurisu
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Correspondence to Naomi Hashimoto.

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Comments

Ben Brown and Anil Nanda, Shreveport, USA

Hashimoto et al. present an interesting study investigating the relationship between histopathologic features of CEA plaques and corresponding CBF and CVR. The implication of this work is that we may be able to refine our indications for CEA based not only on degree of stenosis and symptomatology but by plaque composition as well. Their findings assert higher amounts of IPH correlated with a decrease in CBF. Furthermore, they found the amount of calcification within the plaque was inversely correlated with CVR. These results are a good step in furthering our knowledge of how plaque composition affects a patient’s overall risk for stroke. Currently, the guidelines proposed by multicenter trials, such as NASCET and ECST are the most proven and reliable criteria for patient selection, and more work needs to be done in this area before guidelines can be made based on plaque histopathology.

Dorothea Miller and Ulrich Sure, Essen, Germany

The presented study analyzes the effect of IPH and calcification in carotid arterial plaques on CBF and CVR. The results are interesting and show a trend of a higher risk for ischemic stroke for patients with IPH and absence of intraplaque calcification. Such finding might have an impact on future more aggressive treatment strategies of patients suffering from such plaques. However, before a stratified treatment can be recommended, further prospective studies are needed, since more than half of the patients had to be excluded in the present trial.

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Hashimoto, N., Hama, S., Yamane, K. et al. Carotid arterial intraplaque hemorrhage and calcification influences cerebral hemodynamics. Neurosurg Rev 36, 421–427 (2013). https://doi.org/10.1007/s10143-012-0445-7

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  • DOI: https://doi.org/10.1007/s10143-012-0445-7

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