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<meta name="DC.Title" content="Role of CT Angiographic Plaque Morphologic Characteristics in Addition to Stenosis in Predicting the Symptomatic Side in Carotid Artery Disease" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2078" />
<meta name="DC.Date" content="2010-08-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Atherosclerotic disease of the carotid artery is an important cause of ischemic stroke. We evaluated carotid plaque morphologic features by using CTA in addition to stenosis in the setting of symptomatic hemispheric TIA/stroke to identify factors that may predict plaque activity.

MATERIALS AND METHODS: Six hundred seventy-three patients (408 men; ages, 18–91 years; mean, 65.8 ± 15.2 years) presenting with hemispheric ischemic symptoms and having a CTA that included imaging of both carotid arteries within 24 hours were studied. Scans were interpreted for morphologic features, such as plaque length and width, attenuation, shape, surface, presence and degree of calcification, and ILT in addition to stenosis.

RESULTS: Univariable analysis showed that carotid occlusions ( P = .01, OR = 5.27), high-grade stenosis (70%–99%) ( P = .06, OR = 1.8), and the presence of ILT ( P = .01, OR = 4.33) were highly predictive of the symptomatic side. Smooth plaque ( P = .01, OR = 0.73) and extensive calcification ( P = .03, OR = 0.72) were more commonly associated with the asymptomatic side. There was no correlation between plaque hypoattenuation ( P = .7, OR = 1.06) or ulcerated plaque ( P = .74, OR = 0.955) in predicting the symptomatic side. In a multivariable logistic regression model, the presence of ILT was still found to be significantly associated with the symptomatic side ( P = .048, OR = 3.1) and the presence of extensive calcification, with the asymptomatic carotid artery ( P = .047, OR = 0.69).

CONCLUSIONS: In addition to higher stenosis grades, the presence of ILT is highly predictive of the symptomatic side in carotid disease. Smooth plaque and extensive calcification seem to afford a protective effect. This information may be useful in radiologic risk stratification in carotid disease in addition to the current evidence available based on stenosis criteria alone.

AHA
:   American Heart Association
CTA
:   CT angiography
ILT
:   intraluminal thrombus
MI
:   myocardial infarction
NASCET
:   North America Symptomatic Carotid Endarterectomy Trial
NIHSS
:   National Institutes of Health Stroke Scale
OR
:   odds ratio
TIA
:   transient ischemic attack" />
<meta name="DC.Contributor" content="M. Eesa" />
<meta name="DC.Contributor" content="M.D. Hill" />
<meta name="DC.Contributor" content="A. Al-Khathaami" />
<meta name="DC.Contributor" content="M. Al-Zawahmah" />
<meta name="DC.Contributor" content="P. Sharma" />
<meta name="DC.Contributor" content="B.K. Menon" />
<meta name="DC.Contributor" content="S. Tymchuk" />
<meta name="DC.Contributor" content="A.M. Demchuk" />
<meta name="DC.Contributor" content="M. Goyal" />
<meta name="article:published_time" content="2010-08-01" />
<meta name="article:section" content="Head and Neck" />
<meta name="citation_title" content="Role of CT Angiographic Plaque Morphologic Characteristics in Addition to Stenosis in Predicting the Symptomatic Side in Carotid Artery Disease" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE: &lt;/h3&gt;
&lt;p&gt;Atherosclerotic disease of the carotid artery is an important cause of ischemic stroke. We evaluated carotid plaque morphologic features by using CTA in addition to stenosis in the setting of symptomatic hemispheric TIA/stroke to identify factors that may predict plaque activity.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS: &lt;/h3&gt;
&lt;p&gt;Six hundred seventy-three patients (408 men; ages, 18–91 years; mean, 65.8 ± 15.2 years) presenting with hemispheric ischemic symptoms and having a CTA that included imaging of both carotid arteries within 24 hours were studied. Scans were interpreted for morphologic features, such as plaque length and width, attenuation, shape, surface, presence and degree of calcification, and ILT in addition to stenosis.&lt;/p&gt;&lt;h3&gt;RESULTS: &lt;/h3&gt;
&lt;p&gt;Univariable analysis showed that carotid occlusions (&lt;i&gt;P&lt;/i&gt; = .01, OR = 5.27), high-grade stenosis (70%–99%) (&lt;i&gt;P&lt;/i&gt; = .06, OR = 1.8), and the presence of ILT (&lt;i&gt;P&lt;/i&gt; = .01, OR = 4.33) were highly predictive of the symptomatic side. Smooth plaque (&lt;i&gt;P&lt;/i&gt; = .01, OR = 0.73) and extensive calcification (&lt;i&gt;P&lt;/i&gt; = .03, OR = 0.72) were more commonly associated with the asymptomatic side. There was no correlation between plaque hypoattenuation (&lt;i&gt;P&lt;/i&gt; = .7, OR = 1.06) or ulcerated plaque (&lt;i&gt;P&lt;/i&gt; = .74, OR = 0.955) in predicting the symptomatic side. In a multivariable logistic regression model, the presence of ILT was still found to be significantly associated with the symptomatic side (&lt;i&gt;P&lt;/i&gt; = .048, OR = 3.1) and the presence of extensive calcification, with the asymptomatic carotid artery (&lt;i&gt;P&lt;/i&gt; = .047, OR = 0.69).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS: &lt;/h3&gt;
&lt;p&gt;In addition to higher stenosis grades, the presence of ILT is highly predictive of the symptomatic side in carotid disease. Smooth plaque and extensive calcification seem to afford a protective effect. This information may be useful in radiologic risk stratification in carotid disease in addition to the current evidence available based on stenosis criteria alone.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="twitter:title" content="Role of CT Angiographic Plaque Morphologic Characteristics in Addition to Stenosis in Predicting the Symptomatic Side in Carotid Artery Disease" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Atherosclerotic disease of the carotid artery is an important cause of ischemic stroke. We evaluated carotid plaque morphologic features by using CTA in addition to stenosis in the setting of symptomatic hemispheric TIA/stroke to identify factors that may predict plaque activity.

MATERIALS AND METHODS: Six hundred seventy-three patients (408 men; ages, 18–91 years; mean, 65.8 ± 15.2 years) presenting with hemispheric ischemic symptoms and having a CTA that included imaging of both carotid arteries within 24 hours were studied. Scans were interpreted for morphologic features, such as plaque length and width, attenuation, shape, surface, presence and degree of calcification, and ILT in addition to stenosis.

RESULTS: Univariable analysis showed that carotid occlusions ( P = .01, OR = 5.27), high-grade stenosis (70%–99%) ( P = .06, OR = 1.8), and the presence of ILT ( P = .01, OR = 4.33) were highly predictive of the symptomatic side. Smooth plaque ( P = .01, OR = 0.73) and extensive calcification ( P = .03, OR = 0.72) were more commonly associated with the asymptomatic side. There was no correlation between plaque hypoattenuation ( P = .7, OR = 1.06) or ulcerated plaque ( P = .74, OR = 0.955) in predicting the symptomatic side. In a multivariable logistic regression model, the presence of ILT was still found to be significantly associated with the symptomatic side ( P = .048, OR = 3.1) and the presence of extensive calcification, with the asymptomatic carotid artery ( P = .047, OR = 0.69).

CONCLUSIONS: In addition to higher stenosis grades, the presence of ILT is highly predictive of the symptomatic side in carotid disease. Smooth plaque and extensive calcification seem to afford a protective effect. This information may be useful in radiologic risk stratification in carotid disease in addition to the current evidence available based on stenosis criteria alone.

AHA
:   American Heart Association
CTA
:   CT angiography
ILT
:   intraluminal thrombus
MI
:   myocardial infarction
NASCET
:   North America Symptomatic Carotid Endarterectomy Trial
NIHSS
:   National Institutes of Health Stroke Scale
OR
:   odds ratio
TIA
:   transient ischemic attack" />
<meta name="og-title" property="og:title" content="Role of CT Angiographic Plaque Morphologic Characteristics in Addition to Stenosis in Predicting the Symptomatic Side in Carotid Artery Disease" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/7/1254" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Atherosclerotic disease of the carotid artery is an important cause of ischemic stroke. We evaluated carotid plaque morphologic features by using CTA in addition to stenosis in the setting of symptomatic hemispheric TIA/stroke to identify factors that may predict plaque activity.

MATERIALS AND METHODS: Six hundred seventy-three patients (408 men; ages, 18–91 years; mean, 65.8 ± 15.2 years) presenting with hemispheric ischemic symptoms and having a CTA that included imaging of both carotid arteries within 24 hours were studied. Scans were interpreted for morphologic features, such as plaque length and width, attenuation, shape, surface, presence and degree of calcification, and ILT in addition to stenosis.

RESULTS: Univariable analysis showed that carotid occlusions ( P = .01, OR = 5.27), high-grade stenosis (70%–99%) ( P = .06, OR = 1.8), and the presence of ILT ( P = .01, OR = 4.33) were highly predictive of the symptomatic side. Smooth plaque ( P = .01, OR = 0.73) and extensive calcification ( P = .03, OR = 0.72) were more commonly associated with the asymptomatic side. There was no correlation between plaque hypoattenuation ( P = .7, OR = 1.06) or ulcerated plaque ( P = .74, OR = 0.955) in predicting the symptomatic side. In a multivariable logistic regression model, the presence of ILT was still found to be significantly associated with the symptomatic side ( P = .048, OR = 3.1) and the presence of extensive calcification, with the asymptomatic carotid artery ( P = .047, OR = 0.69).

CONCLUSIONS: In addition to higher stenosis grades, the presence of ILT is highly predictive of the symptomatic side in carotid disease. Smooth plaque and extensive calcification seem to afford a protective effect. This information may be useful in radiologic risk stratification in carotid disease in addition to the current evidence available based on stenosis criteria alone.

AHA
:   American Heart Association
CTA
:   CT angiography
ILT
:   intraluminal thrombus
MI
:   myocardial infarction
NASCET
:   North America Symptomatic Carotid Endarterectomy Trial
NIHSS
:   National Institutes of Health Stroke Scale
OR
:   odds ratio
TIA
:   transient ischemic attack" />
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      <h1 class="highwire-cite-title" id="page-title">Role of CT Angiographic Plaque Morphologic Characteristics in Addition to Stenosis in Predicting the Symptomatic Side in Carotid Artery Disease</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">M. Eesa</span>, <span class="highwire-citation-author" data-delta="1">M.D. Hill</span>, <span class="highwire-citation-author" data-delta="2">A. Al-Khathaami</span>, <span class="highwire-citation-author" data-delta="3">M. Al-Zawahmah</span>, <span class="highwire-citation-author" data-delta="4">P. Sharma</span>, <span class="highwire-citation-author" data-delta="5">B.K. Menon</span>, <span class="highwire-citation-author" data-delta="6">S. Tymchuk</span>, <span class="highwire-citation-author" data-delta="7">A.M. Demchuk</span> and <span class="highwire-citation-author" data-delta="8">M. Goyal</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">August 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1254-1260; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2078 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9773--6483579687" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">M. Eesa </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BEesa%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Eesa%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AM.%2BEesa%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">M.D. Hill </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.D.%2BHill%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hill%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AM.D.%2BHill%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">A. 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<p id="p-1"><strong>BACKGROUND AND PURPOSE: </strong>Atherosclerotic disease of the carotid artery is an important cause of ischemic stroke. We evaluated carotid plaque morphologic features by using CTA in addition to stenosis in the setting of symptomatic hemispheric TIA/stroke to identify factors that may predict plaque activity.</p>
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<p id="p-2"><strong>MATERIALS AND METHODS: </strong>Six hundred seventy-three patients (408 men; ages, 18–91 years; mean, 65.8 ± 15.2 years) presenting with hemispheric ischemic symptoms and having a CTA that included imaging of both carotid arteries within 24 hours were studied. Scans were interpreted for morphologic features, such as plaque length and width, attenuation, shape, surface, presence and degree of calcification, and ILT in addition to stenosis.</p>
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<p id="p-3"><strong>RESULTS: </strong>Univariable analysis showed that carotid occlusions (<em>P</em> = .01, OR = 5.27), high-grade stenosis (70%–99%) (<em>P</em> = .06, OR = 1.8), and the presence of ILT (<em>P</em> = .01, OR = 4.33) were highly predictive of the symptomatic side. Smooth plaque (<em>P</em> = .01, OR = 0.73) and extensive calcification (<em>P</em> = .03, OR = 0.72) were more commonly associated with the asymptomatic side. There was no correlation between plaque hypoattenuation (<em>P</em> = .7, OR = 1.06) or ulcerated plaque (<em>P</em> = .74, OR = 0.955) in predicting the symptomatic side. In a multivariable logistic regression model, the presence of ILT was still found to be significantly associated with the symptomatic side (<em>P</em> = .048, OR = 3.1) and the presence of extensive calcification, with the asymptomatic carotid artery (<em>P</em> = .047, OR = 0.69).</p>
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<p id="p-4"><strong>CONCLUSIONS: </strong>In addition to higher stenosis grades, the presence of ILT is highly predictive of the symptomatic side in carotid disease. Smooth plaque and extensive calcification seem to afford a protective effect. This information may be useful in radiologic risk stratification in carotid disease in addition to the current evidence available based on stenosis criteria alone.</p>
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</div><div class="section glossary" id="glossary-1"><h2>Abbreviations</h2><dl id="def-list-1"><dt id="def-item-1">AHA<span class="def-item-dt-sep"></span></dt><dd>American Heart Association<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">CTA<span class="def-item-dt-sep"></span></dt><dd>CT angiography<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">ILT<span class="def-item-dt-sep"></span></dt><dd>intraluminal thrombus<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">MI<span class="def-item-dt-sep"></span></dt><dd>myocardial infarction<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">NASCET<span class="def-item-dt-sep"></span></dt><dd>North America Symptomatic Carotid Endarterectomy Trial<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">NIHSS<span class="def-item-dt-sep"></span></dt><dd>National Institutes of Health Stroke Scale<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">OR<span class="def-item-dt-sep"></span></dt><dd>odds ratio<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">TIA<span class="def-item-dt-sep"></span></dt><dd>transient ischemic attack</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/31/7/1254.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 31</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 7 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Aug 2010 </div></div>
      
      
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      <div class="highwire-cite-title">Role of CT Angiographic Plaque Morphologic Characteristics in Addition to Stenosis in Predicting the Symptomatic Side in Carotid Artery Disease</div>  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1254-1260; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2078 </span></div>
  
  
  
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      <div class="highwire-cite-title">Role of CT Angiographic Plaque Morphologic Characteristics in Addition to Stenosis in Predicting the Symptomatic Side in Carotid Artery Disease</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Eesa</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">M.D.</span> <span class="nlm-surname">Hill</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Al-Khathaami</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Al-Zawahmah</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Sharma</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">B.K.</span> <span class="nlm-surname">Menon</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Tymchuk</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">A.M.</span> <span class="nlm-surname">Demchuk</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Goyal</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1254-1260; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2078 </span></div>
  
  
  
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