{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T13:40:34Z","timestamp":1791726034442,"version":"4.3.4"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2014,5,22]]},"abstract":"\n Background<\/jats:title>\n \n The European Carotid Surgery Trial (\n ECST<\/jats:styled-content>\n ) risk model is a validated tool for predicting cerebrovascular risk in patients with symptomatic carotid disease. Carotid plaque hemorrhage as detected by\n MRI<\/jats:styled-content>\n (\n MRIPH<\/jats:styled-content>\n ) and microembolic signals (\n MES<\/jats:styled-content>\n ) detected by transcranial Doppler (\n TCD<\/jats:styled-content>\n ) are 2 emerging modalities in assessing instability of the carotid plaque. The aim of this study was to assess the strength of association of\n MES<\/jats:styled-content>\n and\n MRIPH<\/jats:styled-content>\n with cerebrovascular recurrence in patients with symptomatic carotid artery disease in comparison with the\n ECST<\/jats:styled-content>\n risk prediction model.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n One hundred and thirty\u2010four prospectively recruited patients (mean [\n SD<\/jats:styled-content>\n ]: age 72 [9.8] years, 33% female) with symptomatic severe (50% to 99%) carotid stenosis underwent preoperative\n TCD<\/jats:styled-content>\n ,\n MRI<\/jats:styled-content>\n of the carotid arteries to assess\n MES<\/jats:styled-content>\n ,\n PH,<\/jats:styled-content>\n and the\n ECST<\/jats:styled-content>\n risk model. Patients were followed up until carotid endarterectomy, recurrent cerebral event, death, or study end. Event\u2010free survival analysis was done using backward conditional Cox regression analysis.\n <\/jats:p>\n \n Of the 123 patients who had both\n TCD<\/jats:styled-content>\n and\n MRI<\/jats:styled-content>\n , 82 (66.7%) demonstrated\n PH<\/jats:styled-content>\n and 46 (37.4%) had\n MES<\/jats:styled-content>\n . 37 (30.1%) cerebrovascular events (21 transient ischemic attacks, 6 amaurosis fugax, and 10 strokes) were observed. Both carotid\n PH<\/jats:styled-content>\n (\n HR<\/jats:styled-content>\n =8.68; 95%\n CI<\/jats:styled-content>\n 2.66 to 28.40,\n P<\/jats:italic>\n <0.001) as well as\n MES<\/jats:styled-content>\n (\n HR<\/jats:styled-content>\n =3.28; 95%\n CI<\/jats:styled-content>\n 1.68 to 6.42,\n P<\/jats:italic>\n =0.001) were associated with cerebrovascular event recurrence. Combining\n MES<\/jats:styled-content>\n and\n MRIPH<\/jats:styled-content>\n improved the strength of association (\n HR<\/jats:styled-content>\n =0.74, 95%\n CI<\/jats:styled-content>\n 0.65 to 0.83;\n P<\/jats:italic>\n <0.001). The\n ECST<\/jats:styled-content>\n risk model was not associated with recurrence (\n HR<\/jats:styled-content>\n =0.86; 95%\n CI<\/jats:styled-content>\n 0.45 to 1.65;\n P<\/jats:italic>\n =0.65).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The presence of carotid plaque hemorrhage is better associated with recurrent cerebrovascular events in patients with symptomatic severe carotid stenosis than the presence of microembolic signals; combining\n MES<\/jats:styled-content>\n and\n MRIPH<\/jats:styled-content>\n , further improves the association while the\n ECST<\/jats:styled-content>\n risk score was insignificant.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.113.000173","type":"journal-article","created":{"date-parts":[[2014,6,4]],"date-time":"2014-06-04T03:54:25Z","timestamp":1401854065000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":37,"title":["Risk Factors Associated With Cerebrovascular Recurrence in Symptomatic Carotid Disease: A Comparative Study of Carotid Plaque Morphology, Microemboli Assessment and the European Carotid Surgery Trial Risk Model"],"prefix":"10.1161","volume":"3","author":[{"given":"Nishath","family":"Altaf","sequence":"first","affiliation":[{"name":"Radiological Sciences, Division of Clinical Neurosciences, University of Nottingham, Nottingham, UK"},{"name":"Department of Vascular and Endovascular Surgery, Queen's Medical Centre, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neghal","family":"Kandiyil","sequence":"additional","affiliation":[{"name":"Radiological Sciences, Division of Clinical Neurosciences, University of Nottingham, Nottingham, UK"},{"name":"Department of Vascular and Endovascular Surgery, Queen's Medical Centre, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akram","family":"Hosseini","sequence":"additional","affiliation":[{"name":"Radiological Sciences, Division of Clinical Neurosciences, University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajnikant","family":"Mehta","sequence":"additional","affiliation":[{"name":"Medical Statistician, NIHR RDS for the East Midlands, Nottingham Health Science Partners, Queen's Medical Centre, University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shane","family":"MacSweeney","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Queen's Medical Centre, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothee","family":"Auer","sequence":"additional","affiliation":[{"name":"Radiological Sciences, Division of Clinical Neurosciences, University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)15785-1"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)70156-2"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.563056"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(10)70120-4"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000074222.61572.44"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2007.02.072"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.10100198"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2007.09.064"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.106.473066"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000204638.91099.91"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.23918"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0047319"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.23876"},{"key":"e_1_3_4_15_2","first-page":"1123","article-title":"Basic identification criteria of Doppler microembolic signals","volume":"26","author":"Consensus committee of the ninth international cerebral hemodynamic symposium","year":"1996","unstructured":"Consensus committee of the ninth international cerebral hemodynamic symposium . 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