Carotid intraplaque hemorrhage in patients with greater than fifty percent carotid stenosis was associated an acute focal cerebral infarction

Objective: The purpose of this study was to assess associations between acute focal cerebral infarction of anterior circulation and carotid intraplaque hemorrhage (IPH) on magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) in patients with acute neurologic symptoms. Methods: From January 2013 to August 2017, 397 patients (median age, 76 years; male, 78.6%) with acute focal cerebral infarction on diffusion weighted imaging (DWI) were evaluated to determine the maximal wall thickness of the carotid artery, and to look for IPH on carotid MPRAGE sequences. Carotid plaques were defined as carotid artery wall thickness greater than 2 mm in at least two consecutive slices. IPH was defined as the presence in a carotid plaque of MPRAGE signal intensity greater than 200% of the intensity of adjacent muscle. Results: Of these patients with focal cerebral infarction, 165 patients of 195 carotid plaques were included this study. Sixty one (31/3%) carotid plaques of 50 (30.3%) patients were detected MPRAGE positive IPH. Maximal carotid wall thickness and degree of carotid stenosis were significantly higher in the MPRAGE positive group. MPRAGE positive IPH in patients with greater than 50% carotid stenosis was associated with an increased risk of an acute stroke event (p < 0.001), and a 2.64-fold increase in the relative risk of an acute focal stroke, compared to patients with MPRAGE negative scans. Conclusions: Carotid MPRAGE positive IPH in patients with greater than 50% carotid stenosis was associated with acute focal cerebral infarction. MPRAGE positive patients showed higher maximal carotid wall thickness and a higher percentage of carotid stenosis.