Carotid Intraplaque Hemorrhage and Stenosis: At What Stage of Plaque Progression Does Intraplaque Hemorrhage Occur, and When is It Most Likely to Be Associated with Symptoms?

Article Figures & Data

Table 1:

Patient characteristics^{^a}

	Overall	Symptomatic	Asymptomatic	P Value
Total patients included	449	225	224
Total arteries included	449	225	224
Mean age (SD) (yr)	66.4 (16.3)	67.2 (13.1)	65.6 (18.9)	.30
Male (No.) (%)	245 (54.6)	150 (66.7)	95 (42.4)	<.0001
Comorbidities
Coronary artery disease (No.) (%)	110 (24.5)	69 (30.7)	41 (18.3)	.003
Hypertension (No.) (%)	269 (59.9)	154 (68.4)	115 (51.3)	.0002
Hyperlipidemia (No.) (%)	287 (63.9)	177 (78.7)	110 (49.1)	<.0001
Diabetes mellitus (No.) (%)	82 (18.3)	56 (28.9)	26 (11.6)	.0003
Peripheral artery disease (No.) (%)	29 (6.5)	17 (7.6)	12 (5.4)	.44
Obstructive sleep apnea (No.) (%)	85 (18.9)	17 (7.6)	12 (5.4)	.44
Ever smoker (No.) (%)	203 (45.2)	125 (55.6)	78 (34.8)	<.0001
Current smoker (No.) (%)	45 (10.0)	29 (12.9)	16 (7.1)	.06
Mean body mass index (SD)	28.3 (5.3)	28.5 (4.8)	28.1 (5.7)	.39
Imaging characteristics
Arteries without presence of atherosclerotic plaque^{^b} (No.) (%)	202 (45.0)	47 (20.9)	155 (69.2)	<.0001
Mean degree of stenosis^{^c} (SD)	23.8 (33.6)	33.5 (35.2)	14.0 (28.8)	<.0001
Presence of IPH^{^d} (No.) (%)	71 (15.8)	55 (24.4)	16 (7.1)	<.0001

↵a P values pertain to the differences in values between asymptomatic and symptomatic groups.
↵b As mentioned by radiology reports.
↵c Degrees of stenosis were based on NASCET criteria.⁵
↵d Intraplaque hemorrhage was defined as being hyperintense on MPRAGE with intralesional signal intensity of >150% of the ipsilateral sternocleidomastoid muscle.

Table 2:

Multiple regression analysis to determine independent associations with the presence of carotid intraplaque hemorrhage^{^a}

↵a All independent variables are listed in the table. The outcome variable was the presence or absence of carotid intraplaque hemorrhage.

Table 3:

Stratified multiple regression analyses to determine independent associations with the presence of an anterior circulation ischemic event^{^a}

Table 4:

Degree of carotid artery stenosis and prevalence of intraplaque hemorrhage in asymptomatic-versus-symptomatic arteries^{^a}

Degree of Stenosis^{^c}	Prevalence of Intraplaque Hemorrhage^{^b} (%)
Degree of Stenosis^{^c}	All (n = 449 Total)	Asymptomatic (n = 224 Total)	Symptomatic (n = 225 Total)	P Value
<30% (n = 295 total)	13/295 (4.4)	3/180 (1.7)	10/115 (8.7)	.02
30%–69% (n = 79 total)	33/79 (41.8)	5/19 (26.3)	28/60 (46.7)	.18
70%+ (n = 75 total)	25/75 (33.3)	8/25 (32.0)	17/50 (34.0)	.99

↵a P values pertain to the difference in the prevalence of IPH between asymptomatic and symptomatic groups and were calculated using the Fisher exact test. Data are number of arteries per group with intraplaque hemorrhage.
↵b Intraplaque hemorrhage was defined as being hyperintense on MPRAGE with intralesional signal intensity of >150% of the ipsilateral sternocleidomastoid muscle.
↵c Degrees of stenosis were based on the NASCET criteria.⁵