{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:59:46Z","timestamp":1789581586874,"version":"build-2803163510"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>In symptomatic carotid stenosis, treatment decisions are currently primarily based on stenosis degree. We developed a clinical prediction model (Individualized Magnetic Resonance Imaging\u2013Based Stroke Prediction Score Using Plaque Vulnerability for Patients With Symptomatic Carotid Artery Disease [IMPROVE]) incorporating the strong predictor, intraplaque hemorrhage on magnetic resonance imaging, stenosis degree, and risk factors to identify patients with high stroke risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>IMPROVE was developed on data from 5 cohorts of 760 patients with symptomatic carotid disease on optimal medical treatment. Inclusion criteria included a recent transient ischemic attack\/stroke (&lt;6 months), magnetic resonance imaging\u2013based information on intraplaque hemorrhage, no atrial fibrillation, and no immediate revascularization. IMPROVE was based on Cox regression using 5 expert-selected predictors and converted to 3-year ipsilateral ischemic stroke risk after internal validation. IMPROVE-based stratification was compared with care-as-usual using illustrative cutoffs: high risk was defined in IMPROVE as \u2265 median 3-year IMPROVE risk, whereas in care-as-usual, it was \u226550% carotid stenosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Sixty-five ipsilateral ischemic strokes occurred during a median follow-up of 1.2 years (interquartile range, 0.5\u20134.1). The IMPROVE model includes 5 predictors (hazard ratio [95% CI]): degree of stenosis (&lt;50%: reference, 50%\u201369%: 4.54 [2.46\u20138.38], 70%\u201399% stenosis: 7.42 [3.45\u201315.95]), presence of intraplaque hemorrhage (5.61 [2.92\u201310.77]), classification of last event (ocular: reference, cerebral: 3.72 [1.11\u201312.52]), male sex (1.26 [0.64\u20132.48]), and age (1.14 [0.84\u20131.55] per 10-year increase). Internal validation revealed good accuracy (C statistic, 0.82 [95% CI, 0.77\u20130.87]) and no evidence of miscalibration (calibration slope, 0.93). Sensitivity for the illustrative IMPROVE cutoff was 92.6% (90.7\u201394.5) versus 80.6% (77.8\u201383.4) for care-as-usual. Specificity was 54.2% (50.7\u201357.8) for IMPROVE versus 52.9% (49.3\u201356.4) for care-as-usual. Patients stratified by IMPROVE as high risk had a higher incidence of ipsilateral ischemic stroke (24.0%) compared with the care-as-usual classification (20.7%). Among patients classified as lower-risk by IMPROVE and care-as-usual, 2.1% and 5.3%, respectively, experienced an ipsilateral ischemic stroke during follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Using the presence of intraplaque hemorrhage on magnetic resonance imaging and 4 conventional parameters, the IMPROVE model provides accurate individual stroke risk estimates, which may facilitate stratification for revascularization after external validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.124.050020","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T05:01:03Z","timestamp":1746680463000},"page":"2068-2078","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Individualized MRI-Based Stroke Prediction Score Using Plaque Vulnerability for Symptomatic Carotid Artery Disease Patients (IMPROVE)"],"prefix":"10.1161","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9457-3306","authenticated-orcid":true,"given":"Kelly P.H.","family":"Nies","sequence":"first","affiliation":[{"name":"Department of Radiology and Nuclear Medicine (K.P.H.N., R.M.K., I.R., M.E.K.), Maastricht University Medical Center (MUMC+), the Netherlands."},{"name":"Cardiovascular Research Institute Maastricht (CARIM) (K.P.H.N., I.R., R.J.v.O., M.E.K.), Maastricht University Medical Center (MUMC+), the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0785-1345","authenticated-orcid":true,"given":"Luc J.M.","family":"Smits","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Caphri School of Care and Public Health Research, Maastricht University, the Netherlands (L.J.M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2796-729X","authenticated-orcid":true,"given":"Sander M.J.","family":"van Kuijk","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Maastricht University Medical Center (MUMC+), the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0133-9842","authenticated-orcid":true,"given":"Akram A.","family":"Hosseini","sequence":"additional","affiliation":[{"name":"Department of Academic Neurology, Nottingham University Hospitals National Health Service (NHS) Trust, Queens\u2019 Medical Centre, Nottingham, United Kingdom (A.A.H.)."},{"name":"Sir Peter Mansfield Imaging Centre and Mental Health and Clinical Neuroscience Unit, School of Medicine (A.A.H., D.P.A.), University of Nottingham, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4527-3876","authenticated-orcid":true,"given":"Dianne H.K.","family":"van Dam-Nolen","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine (D.H.K.v.D.-N., D.B.), Erasmus University Medical Center Rotterdam, the Netherlands."},{"name":"Department of Neurology (D.H.K.v.D.-N.), Erasmus University Medical Center Rotterdam, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7760-867X","authenticated-orcid":true,"given":"Robert M.","family":"Kwee","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine (K.P.H.N., R.M.K., I.R., M.E.K.), Maastricht University Medical Center (MUMC+), the Netherlands."},{"name":"Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0738-760X","authenticated-orcid":true,"given":"Yoshitaka","family":"Kurosaki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan (Y.K., S.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Rupert","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine (K.P.H.N., R.M.K., I.R., M.E.K.), Maastricht University Medical Center (MUMC+), the Netherlands."},{"name":"Cardiovascular Research Institute Maastricht (CARIM) (K.P.H.N., I.R., R.J.v.O., M.E.K.), Maastricht University Medical Center (MUMC+), the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J.","family":"Nederkoorn","sequence":"additional","affiliation":[{"name":"Department of Neurology, Amsterdam University Medical Center, the Netherlands (P.J.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4840-6854","authenticated-orcid":true,"given":"Pim A.","family":"de Jong","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, the Netherlands (P.A.d.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8979-2603","authenticated-orcid":true,"given":"Daniel","family":"Bos","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine (D.H.K.v.D.-N., D.B.), Erasmus University Medical Center Rotterdam, the Netherlands."},{"name":"Department of Epidemiology (D.B.), Erasmus University Medical Center Rotterdam, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sen","family":"Yamagata","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan (Y.K., S.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothee P.","family":"Auer","sequence":"additional","affiliation":[{"name":"Sir Peter Mansfield Imaging Centre and Mental Health and Clinical Neuroscience Unit, School of Medicine (A.A.H., D.P.A.), University of Nottingham, United Kingdom."},{"name":"NIHR Nottingham Biomedical Research Centre (D.P.A.), University of Nottingham, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0183-5782","authenticated-orcid":true,"given":"Andreas","family":"Schindler","sequence":"additional","affiliation":[{"name":"Institute of Neuroradiology, University Hospital, Ludwig Maximilian University (LMU) Munich, Germany (A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5971-0296","authenticated-orcid":true,"given":"Tobias","family":"Saam","sequence":"additional","affiliation":[{"name":"Die Radiologie, Radiologie 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