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Carotid vulnerable plaque coexisting with cerebral small vessel disease and acute ischemic stroke: a Chinese Atherosclerosis Risk Evaluation study

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Abstract

Objectives

We aimed to investigate the associations between carotid vulnerable plaque features coexisting with cerebral small vessel diseases (CSVDs) and acute ischemic stroke (AIS) and, furthermore, to determine whether coexisting diseases had a stronger association with AIS than a single disease.

Methods

Patients with cerebrovascular symptoms and carotid plaque were recruited from the cross-sectional, multicenter CARE-II study. The population was divided into two groups (AIS and transient ischemic stroke (TIA)). MRI features of carotid plaques (including luminal stenosis and plaque vulnerabilities) and CSVDs (such as white matter hyperintensities (WMHs) and lacunes) were evaluated. Coexisting diseases were defined as the presence of at least one carotid plaque features and one or more CSVDs feature. Multivariate logistic regression was performed to examine the associations between coexisting diseases and AIS.

Results

Of the recruited 634 patients (mean age: 59.1 ± 11.3 years; 429 males), 312 (49.2%) patients had AIS. These subjects had a higher prevalence of carotid vulnerable plaques, lacunes, and moderate-to-severe WMHs (a total Fazekas score of 3–6) than those with TIA (42.6% vs. 29.5%, 59.6% vs. 26.4%, 69.9% vs. 60.6%, respectively, all p < 0.05). Multivariate analysis revealed that carotid plaque features coexisting with lacunes or moderate-to-severe WMHs had a stronger association with AIS compared to carotid lesions alone (all p < 0.05) (i.e., vulnerable plaque coexisting with lacunes vs. vulnerable plaque alone, adjusted odds ratio: 3.67 vs. 1.62).

Conclusions

Carotid vulnerable plaque features coexisting with CSVDs, particularly lacunes, had a stronger association with AIS compared to carotid lesions alone in a large, symptomatic, cohort.

Trial registration

Clinical trial registration URL: http://www.clinicaltrials.gov, unique identifier: NCT02017756

Key Points

• Carotid vulnerable plaque features coexisting with cerebral small vessel diseases, such as lacunes, had a stronger association with acute ischemic stroke compared to single diseases in symptomatic patients.

• A comprehensive assessment of coexisting cerebrovascular diseases may help stratify the risk of acute ischemic stroke.

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Abbreviations

AIS:

Acute ischemic stroke

BMI:

Body mass index

CARE-II:

Chinese Atherosclerosis Risk Evaluation

CSVDs:

Cerebral small vessel diseases

FC:

Fibrous cap

HDL:

High-density lipoprotein

IPH:

Intraplaque hemorrhage

IQR:

Interquartile range

LDL:

Low-density lipoprotein

LRNC:

Lipid-rich necrotic core

MP-RAGE:

Magnetization-prepared rapid acquisition gradient echo

SD:

Standard deviation

TC:

Total cholesterol

TG:

Triglycerides

TIA:

Transient ischemic attack

WASID:

Warfarin-Aspirin Symptomatic Intracranial Disease

WMHs:

White matter hyperintensities

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Acknowledgements

We thank all the CARE-II (Chinese Atherosclerosis Risk Evaluation) investigators for their contributions to the patient recruitment.

Funding

This research was supported by the grants of the National Key R&D Program of China (Grant No. 2017YFC1307900, 2017YFC1307904), National Natural Science Foundation of China (Grant No. 81771825, 81801650, 81571630), Beijing Municipal Science and Technology Commission (Grant No. D171100003017003), and Shanghai Municipal Population and Family Planning Commission (Grant No. 201940060, 20204Y0089).

Author information

Author notes

  1. Dr. Huilin Zhao and Dr. Dan Zhou contributed equally to this manuscript and are co-corresponding authors.

    Hengqu Wu and Jin Li contributed equally as first authors to this work.

Authors and Affiliations

  1. Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

    Jin Li

  2. Department of Radiology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Jianye District, Nanjing, China

    Jin Li & Dan Zhou

  3. Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Hengqu Wu

  4. Department of Neurology, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, China

    Hailun Hang

  5. Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Beibei Sun, Huilin Zhao, Zengai Chen, Yan Zhou & Jianrong Xu

  6. Department of Neurology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Jinmei Chen

  7. Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China

    Xihai Zhao

  8. Department of Radiology, University of Washington, Seattle, WA, USA

    Chun Yuan

Authors
  1. Jin Li
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  2. Hengqu Wu
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  4. Beibei Sun
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  7. Yan Zhou
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  10. Dan Zhou
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  11. Xihai Zhao
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  12. Chun Yuan
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Corresponding authors

Correspondence to Huilin Zhao or Dan Zhou.

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Guarantor

The scientific guarantor of this publication is Huilin Zhao.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• retrospective

• cross-sectional study

• multicenter study

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Li, J., Wu, H., Hang, H. et al. Carotid vulnerable plaque coexisting with cerebral small vessel disease and acute ischemic stroke: a Chinese Atherosclerosis Risk Evaluation study. Eur Radiol 32, 6080–6089 (2022). https://doi.org/10.1007/s00330-022-08757-9

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  • DOI: https://doi.org/10.1007/s00330-022-08757-9

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