The value of coordinated analysis of multimodal atherosclerotic plaque imaging in the assessment of cardiovascular and cerebrovascular events

Abstract

Background: Although atherosclerosis (AS) can affect multiple vascular beds, previous studies have focused on the analysis of single-site AS plaques.

Objective: The aim of this study is to explore the differences or similarities in the characteristics of atherosclerotic plaque found in the internal carotid artery, cerebral artery, and coronary artery between patients with atherosclerotic cardiovascular disease (ASCVD) and those without events.

Methods: Patients aged ≥ 18 years who underwent both high-resolution vessel wall imaging (HR-VWI) and coronary computed tomography angiography (CCTA) were retrospectively collected and categorized into the ASCVD group and the non-event group. The plaques were then categorized into culprit plaques, non-culprit plaques, and non-event plaques. Plaque morphological data such as stenosis, stenosis grades, plaque length (PL), plaque volume (PV), minimal lumen area (MLA), enhancement grade, and plaque composition data such as calcified plaque volume (CPV), fibrotic plaque volume (FPV), fibro-lipid plaque volume (FLPV), lipid plaque volume (LPV), calcified plaque volume ratio (CPR), fibrotic plaque volume ratio (FPR), fibro-lipid plaque ratio (FLPR), lipid plaque volume ratio (LPR), intraplaque hemorrhage volume (IPHV), and intraplaque hemorrhage volume ratio (IPHR)were recorded and analyzed.

Results: A total of 44 patients (mean age 66 years, SD 9 years, 28 men) were included. In cervicocephalic plaques, the ASCVD group had more severe stenosis grades (p = 0.030) and demonstrated significant differences in LPV, LPR, and CPV (p = 0.044, 0.030, 0.020) compared with the non-event group. In coronary plaques, the ASCVD group had plaques with greater stenosis (p < 0.001), more severe stenosis grades (p < 0.001), larger volumes (p = 0.001), longer length (p = 0.008), larger FLPV (p = 0.012), larger FPV (p = 0.002), and higher FPR (p = 0.043) compared with the non-event group. There were significant differences observed in stenosis (HR-VWI, CCTA: p < 0.001, p < 0.001), stenosis grades (HR-VWI, CCTA: p < 0.001, p < 0.001), plaque length (HR-VWI, CCTA: p = 0.028, p < 0.001), and plaque volume (HR-VWI, CCTA: p = 0.013, p = 0.018) between the non-event plaque, non-culprit plaque, and culprit plaque. In the image analysis of HR-VWI, there were differences observed between IPHR (p < 0.001), LPR (p = 0.001), FPV (p = 0.011), and CPV (p = 0.015) among the three groups of plaques. FLPV and FPV were significantly different among the three different plaque types from the coronary artery (p = 0.043, p = 0.022).

Conclusion: There is a consistent pattern of change in plaque characteristics between the cervicocephalic and coronary arteries in the same patient.

Keywords: atherosclerotic cardiovascular disease (ASCVD); coronary computed tomography angiography (CCTA); high-resolution vessel wall imaging (HR-VWI); stroke, coronary heart disease (CHD).

Figure 1

A 65-year-old male patient in the ASCVD group who had a cardiovascular event and a cerebrovascular event. (A) Axial diffusion-weighted imaging detects high-signal-intensity lesions in the left radial coronal area. (B) Magnetic resonance angiography MIP image shows significant stenosis of the M1 segment of the left MCA. (C) CPR images of the M1 segment of left MCA. (D–F) Cross-sectional reconstruction of the corresponding plaque in 3D-T2WI, pre- or post-enhancement 3D-T1WI. (G) CPR images of the LAD. (H–I) Cross-sectional reconstruction and component analysis of the corresponding plaque. A 65-year-old man who presented with dizziness for a week and underwent HR-VWI examination. Diffusion-weighted imaging (A) showed multiple acute and subacute cerebral infarctions in the left radial coronal area. These images (B–F) exhibit atherosclerotic plaque in the M1 segment of the left MCA (C, thin yellow arrow), including thin fibrous cap (D, thin red arrow), necrotic core (D, thin yellow arrow), IPH (E, thin yellow arrow), discontinuity of plaque surface (E, thin red arrow), and positive remodeling. Approximately 4 months after the HR-VWI examination, the patient underwent CCTA examination (G–I) due to acute chest pain. A segmental, eccentric mixed plaque can be seen in the LAD (G, thin yellow arrow). In component analysis (H), the main component of plaque is fibro-lipid tissue. These plaques are considered the culprit plaques clinically. MIP, maximum intensity projection; MCA, middle cerebral artery; CPR, curved planar reformation; LAD, left anterior descending branch; IPH, intraplaque hemorrhage; HR-VWI, high-resolution vessel wall imaging; CCTA, coronary computed tomography.

Figure 2

A 56-year-old male patient in the non-event group. (A) CPR images of the LAD. (B,C) Cross-sectional reconstruction and component analysis of the corresponding plaque. (D) Magnetic resonance angiography MIP image shows significant stenosis of the M1 segment of right MCA. (E) CPR images of the M1 segment of the right MCA. (F–H) Cross-sectional reconstruction of the corresponding plaque in 3D-T2WI, pre- or post-enhancement 3D-T1WI. A 56-year-old man, who was examined for physical examination of CCTA, the most stenotic plaque was located in the LAD coronary artery, and plaque component analysis was predominantly calcified component (B,C). Approximately 5 months later, he visited the hospital due to headache for 5 days. HR-VWI was performed and showed no stroke event; the narrowest plaque was located in the M1 segment of the right MCA (D, thin yellow arrow), and the component analysis showed that the plaque was mainly composed of fibrous component (F–H). CPR, curved planar reformation; LAD, left anterior descending branch; MIP, maximum intensity projection; MCA, middle cerebral artery; HR-VWI, high-resolution vessel wall imaging; CCTA, coronary computed tomography.