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Association between high-risk extracranial carotid plaque and covert brain infarctions and cerebral microbleeds

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Purpose

Covert brain infarctions (CBIs) and cerebral microbleeds (CMBs) represent subclinical sequelae of ischemic and hemorrhagic cerebral small vessel disease, respectively. In addition to thromboembolic stroke, carotid atherosclerosis has been associated with downstream vascular brain injury, including inflammation and small vessel disease. The specific plaque features responsible for this are unknown. We aimed to determine the association of specific vulnerable carotid plaque features to CBIs and CMBs to better understand the relation of large and small vessel disease in a single-center retrospective observational study.

Methods

Intraplaque hemorrhage (IPH) and plaque ulceration were recorded on carotid MRA and total, cortical, and lacunar CBIs and CMBs were recorded on brain MR in 349 patients (698 carotid arteries). Multivariable Poisson regression was performed to relate plaque features to CBIs and CMBs. Within-subject analysis in those with unilateral IPH and ulceration was performed with Poisson regression.

Results

Both IPH and plaque ulceration were associated with total CBI (prevalence ratios (PR) 3.33, 95% CI: 2.16–5.15 and 1.91, 95% CI: 1.21–3.00, respectively), after adjusting for stenosis, demographic, and vascular risk factors. In subjects with unilateral IPH, PR was 2.83, 95% CI: 1.76–4.55, for CBI in the ipsilateral hemisphere after adjusting for stenosis. Among those with unilateral ulceration, PR was 1.82, 95% CI: 1.18–2.81, for total CBI ipsilateral to ulceration after adjusting for stenosis. No statistically significant association was seen with CMBs.

Conclusion

Both IPH and plaque ulceration are associated with total, cortical, and lacunar type CBIs but not CMBs suggesting that advanced atherosclerosis contributes predominantly to ischemic markers of subclinical vascular injury.

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Data availability

The data that support this study are available from the corresponding author on reasonable request.

Abbreviations

CBI:

Covert brain infarction

CMB:

Cerebral microbleed

IPH:

Intraplaque hemorrhage

PR:

Prevalence ratio

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Acknowledgements

None.

Funding

This work was supported by a Radiological Society of North America Research Scholar Grant, General Electric Radiology Research Academic Fellowship, and a grant for the Study Design and Biostatistics Center, with funding, in part, from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, grant 8UL1TR000105 (formerly UL1RR025764). American Heart Association grant number 17SDG33460420.

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Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A141, Salt Lake City, UT, 84135, USA

    Hediyeh Baradaran, Sinead Culleton, Matthew D. Alexander, J. Rock Hadley, Seong-Eun Kim, Dennis L. Parker & J. Scott McNally

  2. Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA

    Greg Stoddard

  3. Department of Neurology, Boston University, Boston, MA, USA

    J. Rafael Romero

Authors
  1. Hediyeh Baradaran
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  2. Sinead Culleton
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  9. J. Scott McNally
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Hediyeh Baradaran, Sinead Culleton, Greg Stoddard, and J Scott McNally. The first draft of the manuscript was written by Hediyeh Baradaran and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Hediyeh Baradaran.

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Conflict of interest statement

We declare that we have no conflict of interest.

Ethics approval

This research study was conducted retrospectively from data obtained for clinical purposes at the University of Utah Health Medical Center. The University of Utah Institutional Review Board approved this study.

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All study procedures were approved by the Institutional Review Board at the University of Utah and informed consent was not required given retrospective nature of the study.

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Baradaran, H., Culleton, S., Stoddard, G. et al. Association between high-risk extracranial carotid plaque and covert brain infarctions and cerebral microbleeds. Neuroradiology 65, 287–295 (2023). https://doi.org/10.1007/s00234-022-03062-0

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