Carotid intraplaque hemorrhage predicts recurrent symptoms in patients with high-grade carotid stenosis

Background and Purpose - Carotid intraplaque hemorrhage ( IPH), known to be associated with plaque instability, may convey a higher stroke risk. The aim of this study was to assess whether the identification of IPH by MRI predicts recurrent clinical cerebrovascular events. Methods - Sixty-six patients with high-grade symptomatic carotid stenosis underwent MRI of the carotid arteries and were followed until carotid endarterectomy or 30 days. Results - Of the 66 patients with a median follow up of 33.5 days, 44 ( 66.7%) were found on MRI to have ipsilateral carotid IPH. Fifteen recurrent events were associated with ipsilateral carotid IPH. Only 2 recurrent events occurred in the absence of IPH. IPH increased the risk of recurrent ischemia ( hazard ratio=4.8; 95% CI=1.1 to 20.9, P<0.05). Conclusion - IPH as detected by MRI predicts recurrent cerebrovascular events in patients with symptomatic high-grade carotid stenosis.