Neurosurgical Review

, Volume 36, Issue 3, pp 421–427 | Cite as

Carotid arterial intraplaque hemorrhage and calcification influences cerebral hemodynamics

  • Naomi Hashimoto
  • Seiji Hama
  • Kanji Yamane
  • Kaoru Kurisu
Original Article

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.

Keywords

Cerebral blood flow Cerebrovascular reactivity Carotid arterial plaque Intraplaque hemorrhage Calcification Fibrous Stenosis 

Notes

References

  1. 1.
    Altaf N, MacSweeney ST, Gladman J, Auer DP (2007) Carotid intraplaque hemorrhage predicts recurrent symptoms in patients with high-grade carotid stenosis. Stroke 38:1633–1635CrossRefPubMedGoogle Scholar
  2. 2.
    Charles W (1991) MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99 %) or with mild (0–29 %) carotid stenosis. Lancet 337:1235–1243CrossRefGoogle Scholar
  3. 3.
    Derdeyn CP, Grubb RL Jr, Powers WJ (1999) Cerebral hemodynamic impairment. methods of measurement and association with stroke risk. Neurology 22(53):251–259CrossRefGoogle Scholar
  4. 4.
    Endo S, Hirashima Y, Kurimoto M, Kuwayama N, Nishijima M, Takaku A (1996) Acute pathologic features with angiographic correlates of the nearly or completely occluded lesions of the cervical internal carotid artery. Surg Neurol 46:222–228CrossRefPubMedGoogle Scholar
  5. 5.
    Fuster V, Badimon L, Badimon JJ, Chesebro JH (1992) The pathogenesis of coronary artery disease and the acute coronary syndromes (1). N Engl J Med 326(4):242–250CrossRefPubMedGoogle Scholar
  6. 6.
    Hatsukami TS, Ferguson MS, Beach KW, Gordon D, Detmer P, Burns D, Alpers C, Strandness DE Jr (1997) Carotid plaque morphology and clinical events. Stroke 28:95–100CrossRefPubMedGoogle Scholar
  7. 7.
    Johnson RC, Leopold JA, Loscalzo J (2006) Vascular calcification: pathobiological mechanisms and clinical implications. Circ Res 99:1044–1059CrossRefPubMedGoogle Scholar
  8. 8.
    Kolodgie FD, Gold HK, Burke AP, Fowler DR, Kruth HS, Weber DK, Farb A, Guerrero LJ, Hayase M, Kutys R, Narula J, Finn AV, Virmani R (2003) Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med 349:2316–2325CrossRefPubMedGoogle Scholar
  9. 9.
    Kume S, Hama S, Yamane K, Wada S, Nishida T, Kurisu K (2010) Vulnerable carotid arterial plaque causing repeated ischemic stroke can be detected with B-mode ultrasonography as a mobile component: Jellyfish sign. Neurosurg Rev 33:419–430CrossRefPubMedGoogle Scholar
  10. 10.
    Kwee RM (2010) Systematic review on the association between calcification in carotid plaques and clinical ischemic symptoms. J Vasc Surg 51(4):1015–1025CrossRefPubMedGoogle Scholar
  11. 11.
    Lammie GA, Sandercock PA, Dennis MS (1999) Recently occluded intracranial and extracranial carotid arteries. Relevance of the unstable atherosclerotic plaque. Stroke 30:1319–1325CrossRefPubMedGoogle Scholar
  12. 12.
    Lennihan L, Kupsky WJ, Mohr JP, Hauser WA, Correll JW, Quest DO (1987) Lack of association between carotid plaque hematoma and ischemic cerebral symptoms. Stroke 18:879–881CrossRefPubMedGoogle Scholar
  13. 13.
    Lusby RJ, Ferrell LD, Ehrenfeld WK, Stoney RJ, Wylie EJ (1982) Carotid plaque hemorrhage. Arch Surg 117:1479–1488CrossRefPubMedGoogle Scholar
  14. 14.
    Markus H, Cullinane M (2001) Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with carotid artery stenosis and occlusion. Brain 124:457–467CrossRefPubMedGoogle Scholar
  15. 15.
    Momjian-Mayor I, Baron JC (2005) The pathophysiology of watershed infarction in internal carotid artery disease. Review of cerebral perfusion studies. Stroke 36:567–577CrossRefPubMedGoogle Scholar
  16. 16.
    Nandalur KR, Baskurt E, Hagspiel KD, Finch M, Phillips CD, Bollampally SR, Kramer CM (2006) Carotid artery calcification on CT May independently predict stroke risk. AJR Am J Roentgenol 186:547–552CrossRefPubMedGoogle Scholar
  17. 17.
    Nandalur KR, Baskurt E, Hagspiel KD, Phillips CD, Kramer CM (2005) Calcified carotid atherosclerotic plaque is associated less with ischemic symptoms than is noncalcified plaque on MDCT. AJR Am J Roentgenol 184:295–298CrossRefPubMedGoogle Scholar
  18. 18.
    Nighoghossian N, Derex L, Douek P (2005) The vulnerable carotid artery plaque. Current imaging methods and new perspectives. Stroke 36:2764–2772CrossRefPubMedGoogle Scholar
  19. 19.
    North American Symptomatic Carotid Endarterectomy Trial (NASCET) Steering Committee (1991) North American symptomatic carotid endarterectomy trial methods, patient characteristics, and progress. Stroke 22:711–720CrossRefGoogle Scholar
  20. 20.
    Persson AV, Robichaux WT, Silverman M (1983) The natural history of carotid plaque development. Arch Surg 118:1048–1052CrossRefPubMedGoogle Scholar
  21. 21.
    Seeger JM, Barratt E, Lawson GA, Klingman N (1995) The relationship between carotid plaque composition, plaque morphology, and neurologic symptoms. J Surg Res 58:330–336CrossRefPubMedGoogle Scholar
  22. 22.
    Shaalan WE, Cheng H, Gewertz B, McKinsey JF, Schwartz LB, Katz D, Cao D, Desai T, Glagov S, Bassiouny HS (2004) Degree of carotid plaque calcification in relation to symptomatic outcome and plaque inflammation. J Vasc Surg 40:262–269CrossRefPubMedGoogle Scholar
  23. 23.
    Uno M, Hamazaki F, Kohno T, Sebe A, Horiguchi H, Nagahiro S (2001) Combined therapeutic approach of intra-arterial thrombolysis and carotid endarterectomy in selected patients with acute thrombotic carotid occlusion. J Vasc Surg 34:532–540CrossRefPubMedGoogle Scholar
  24. 24.
    Virmani R, Kolodgie FD, Burke AP, Finn AV, Gold HK, Tulenko TN, Wrenn SP, Narula J (2005) Atherosclerotic plaque progression and vulnerability to rupture: angiogenesis as a source of intraplaque hemorrhage. Arterioscler Thromb Vasc Biol 25:2054–2061CrossRefPubMedGoogle Scholar
  25. 25.
    Yamane K, Shima T, Nishida M, Hatayama T, Yamanaka C (2000) Changes in cerebral blood flow after carotid endarterectomy. Keio J Med 49(Suppl 1):A80–A82PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Naomi Hashimoto
    • 1
  • Seiji Hama
    • 2
  • Kanji Yamane
    • 1
  • Kaoru Kurisu
    • 2
  1. 1.Department of NeurosurgeryChugoku Rousai HospitalHiroshimaJapan
  2. 2.Department of Neurosurgery, Graduate School of Biomedical ScienceHiroshima UniversityHiroshimaJapan

Personalised recommendations