Document Detail

Carotid plaque inflammation is associated with cerebral microembolism in patients with recent transient ischemic attack or stroke: a pilot study.
MedLine Citation:
PMID:  20639303     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Cerebral infarcts distal to carotid stenoses are thought to be caused by emboli from inflamed, destabilized plaques. We hypothesized that microembolic signals (MES) on transcranial Doppler will be associated with carotid plaque inflammation on (18)F fluorodeoxyglucose positron-emission tomography (FDG PET) in recently symptomatic patients.
METHODS AND RESULTS: Sixteen patients presenting with recent (47 ± 31 days) anterior circulation transient ischemic attack or minor stroke and 50% to 99% stenosis of the ipsilateral carotid bifurcation underwent FDG PET, high-resolution black-blood carotid MRI, and transcranial Doppler for detection of MES. Patients with potential cardiac sources of emboli or contralateral MES were excluded. Regions of interest defined on the coregistered MRI were used to measure FDG standardized uptake values (with Rousset partial volume correction) from the index and contralateral carotid plaques and artery. Ipsilateral MES were detected in 7 patients (MES+ group) and absent in 8 (MES- group). There was a significant difference in index-to-contralateral plaque standardized uptake value ratio between MES+ (median, 1.05; first to third quartile, 0.96 to 1.32) and MES- (median, 0.76; first to third quartile, 0.62 to 0.94) patients (P=0.005). The interval from symptom onset to PET and percent index carotid stenosis were not different between the 2 groups (P=0.68 and P=0.48, respectively).
CONCLUSIONS: In this sample of recently symptomatic patients with carotid stenosis, an association was found between in vivo measures of plaque inflammation detected by FDG PET and the presence of transcranial Doppler MES. These findings strengthen the notion that embolic events distal to carotid stenoses are related to plaque inflammation, and FDG PET may be useful in the investigation of culprit carotid lesions.
Ramez Reda Moustafa; David Izquierdo-Garcia; Tim D Fryer; Martin J Graves; James H F Rudd; Jonathan H Gillard; Peter L Weissberg; Jean-Claude Baron; Elizabeth A Warburton
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-07-16
Journal Detail:
Title:  Circulation. Cardiovascular imaging     Volume:  3     ISSN:  1942-0080     ISO Abbreviation:  Circ Cardiovasc Imaging     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-15     Completed Date:  2010-10-04     Revised Date:  2011-09-06    
Medline Journal Info:
Nlm Unique ID:  101479935     Medline TA:  Circ Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  536-41     Citation Subset:  IM    
Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
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MeSH Terms
Aged, 80 and over
Carotid Stenosis / complications*,  radionuclide imaging
Fluorodeoxyglucose F18 / diagnostic use
Inflammation / complications*,  radionuclide imaging
Intracranial Embolism / etiology*,  ultrasonography
Ischemic Attack, Transient / etiology*,  ultrasonography
Magnetic Resonance Imaging
Middle Aged
Pilot Projects
Positron-Emission Tomography
Predictive Value of Tests
Radiopharmaceuticals / diagnostic use
Stroke / etiology*,  ultrasonography
Time Factors
Ultrasonography, Doppler, Transcranial
Grant Support
//British Heart Foundation
Reg. No./Substance:
0/Radiopharmaceuticals; 63503-12-8/Fluorodeoxyglucose F18

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