Carotid plaques from symptomatic patients with mild stenosis is associated with intraplaque hemorrhage

Valentina Nardi, John Benson, Melanie C. Bois, Luca Saba, Anthony S. Larson, Ilke Özcan, Ali Ahmad, David W. Morse, Fredric B. Meyer, Waleed Brinjikji, Giuseppe Lanzino, Lilach O. Lerman, Luis E. Savastano, Amir Lerman

Research output: Contribution to journalArticlepeer-review


Carotid plaque vulnerability features beyond the degree of stenosis may play a key role in the pathogenesis and recurrence of ischemic cerebrovascular events. This study sought to compare intraplaque hemorrhage (IPH) as a marker of plaque vulnerability in symptomatic patients with mild (<50%), moderate (50%-69%), and severe (≥70%) carotid artery stenosis. We included patients who experienced ischemic cerebrovascular events with no other identifiable sources and underwent carotid endarterectomy for mild (n=32), moderate (n=47), and severe (n=58) carotid artery stenosis. The degree of stenosis and imaging hallmarks were assessed by computed tomography angiography or magnetic resonance angiography. Plaque specimens were stained with hematoxylin and eosin and Movat pentachrome staining. Carotid plaques of patients with mild stenosis had a higher extent of IPH (%) on tissue analysis compared with patients with moderate (mild, 15.7% [interquartile range, 7.8%-26.7%]; moderate, 3.9% [0.0%-9.2%]; P<0.001) and severe carotid artery stenosis (mild, 15.7% [interquartile range, 7.8%-26.7%]; severe, 2.5% [interquartile range, 0.0%-11.2%]; P<0.001). When considering the degree of carotid artery stenosis as a continuous variable, a lower lumen narrowing was associated with higher extent of IPH (P<0.001; R, -0.329). Our major finding is the association of IPH with mild carotid artery stenosis based on histological analysis. The current study may suggest that IPH potentially plays a role in the mechanism of stroke in patients with nonobstructive carotid stenosis.

Original languageEnglish (US)
Pages (from-to)271-282
Number of pages12
Issue number1
StatePublished - Jan 1 2022


  • Atherosclerotic plaque
  • Carotid artery diseases
  • Carotid stenosis
  • Cerebrovascular accidents
  • Ischemic stroke

ASJC Scopus subject areas

  • Internal Medicine


Dive into the research topics of 'Carotid plaques from symptomatic patients with mild stenosis is associated with intraplaque hemorrhage'. Together they form a unique fingerprint.

Cite this