Cholesterol Crystal Embolism in a Patient with Spontaneous Ruptured Aortic Plaques Identified by Non-Obstructive General Angioscopy.

Cholesterol crystal (CC) embolism is a disease in which CCs from atherosclerotic lesions embolize peripheral arteries, causing organ dysfunction. In this case, a patient with spontaneously ruptured aortic plaques (SRAPs) identified by non-obstructive general angioscopy (NOGA) may have developed a CC embolism. This is the first report of a CC embolism in a patient with SRAPs identified using NOGA, which further supports the previously speculated pathogenesis of CC embolism due to SRAPs.

[Cardiac CT in 2024]. / CT cardiaque en 2024.

Coronary Computed Tomography Angiography (CCTA) has now become an established tool in the diagnostic process for patients suspected of coronary artery disease. In light of rapid technological development, CCTA has evolved into an imaging modality providing both anatomical and functional information to guide patient management. In this article, we describe the role of cardiac CT in assessing atherosclerotic plaque, chest pain evaluation, cardiovascular risk stratification, planning and guiding coronary intervention, as well as structural heart diseases.

Le scanner coronarien est actuellement un outil reconnu dans le processus diagnostique des patients chez qui on suspecte une maladie coronarienne. Bénéficiant d'un développement technologique rapide et procurant des informations tant morphologiques que fonctionnelles, le CT cardiaque devient une modalité d'imagerie incontournable pour orienter la prise en charge des patients. Dans cet article, nous décrivons le rôle du CT cardiaque dans l'évaluation de la plaque d'athérosclérose, des douleurs thoraciques, de la stratification du risque cardiovasculaire, de la planification et du guidage de l'intervention coronarienne, ainsi que des maladies cardiaques structurelles.

Intra- and inter-reader reproducibility in quantitative coronary plaque analysis on coronary computed tomography angiography.

PURPOSE: Coronary artery plaque burden, low attenuation non-calcified plaque (LAP), and pericoronary adipose tissue (PCAT) on coronary CT angiography (CCTA), have been linked to future cardiac events. The purpose of this study was to evaluate intra- and inter reader reproducibility in the quantification of coronary plaque burden and its characteristics using an artificial intelligence-enhanced semi-automated software. MATERIALS AND METHODS: A total of 10 women and 6 men, aged 52 (IQR 49-58) underwent CCTA using a Siemens Somatom Force, Somatom Definition AS and Somatom Definition Flash scanners. Two expert readers utilized dedicated semi-automatic software (vascuCAP, Elucid Bioimaging, Wenham, MA) to assess calcified plaque, low attenuation plaque and PCAT. Readers were blinded to all clinical information and repeated their analysis at 6 weeks in random order to minimize recall bias. Data analysis was performed on the right and left coronary arteries. Intra- and inter-reader reproducibility was compared using Pearson correlation coefficient, while absolute values between analyses and readers were compared with paired non-parametric tests. This is a sub-study of the Specialized Center of Research Excellence (SCORE) clinical trial (5U54AG062334). RESULTS: A total of 64 vessels from 16 patients were analyzed. Intra-reader Pearson correlation coefficients for calcified plaque volume, LAP volume and PCAT volumes were 0.96, 0.99 and 0.92 for reader 1 and 0.94, 0.94 and 0.95 for reader 2, respectively, (all p < 0.0001). Inter-reader Pearson correlation coefficients for calcified plaque volume, LAP and PCAT volumes were 0.92, 0.96 and 0.78, and 0.99, 0.99 and 0.93 on the second analyses, all had a p value <0.0001. There was no significant bias on the corresponding Bland-Altman analyses. CONCLUSION: Volume measurement of coronary plaque burden and PCAT volume can be performed with high intra- and inter-reader agreement.

Multiple plaque ruptures healing assessed by serial optical coherence tomography.

A 30-year-old man with hypertension presented to the emergency department with a 30-minute episode of diaphoresis and chest pain, acute inferior myocardial infarction was diagnosed on electrocardiogram.

Thin aortic arch plaque is associated with the development of atrial fibrillation for embolic stroke of undetermined source in patients with an insertable cardiac monitor.

BACKGROUND AND OBJECTIVE: This study's objective is to investigate whether mild aortic arch plaque is associated with the development of atrial fibrillation (AF) in stroke patients with embolic stroke of undetermined source (ESUS) during the first year following the implantation of an insertable cardiac monitor (ICM). METHODS: The participants in this cross-sectional observational study were consecutive patients with ESUS, even after transesophageal echocardiography. We assessed the relationship between the thickness of the participants' aortic arch plaque and AF detected after ICM implantation. RESULTS: Of the 50 consecutive patients with ESUS enrolled in this study, 12 (24%) developed AF. We observed that thicker aortic arch plaque was associated with undetected AF (2.3 mm vs. 1.2 mm, p < 0.001). Aortic arch plaque thickness was independent associated with undetected AF (OR 54.00, 95% CI 2.706-1077.544, p = 0.009). When the cut-off value for aortic arch plaque thickness was 1.8 mm, the sensitivity and specificity were 71.1% and 91.7%, respectively (95% CI = 0.75-0.98, p < 0.001). Also, patients having both aortic arch plaque with a thickness < 1.8 mm and a CHADS2 score ≥ 4 were more likely to have detectable AF than no AF (88% vs. 12%, p < 0.001). CONCLUSION: A thinner aortic arch plaque was associated with the development of AF. Patients with mild aortic plaques below 4 mm but ≥1.8 mm in thickness and without other high-risk features are less likely to have paroxysmal AF on ICM, and these plaques may be a possible source of embolism for their strokes.

A novel method of carotid artery wall imaging: black-blood CT.

OBJECTIVES: To evaluate the application of black-blood CT (BBCT) in carotid artery wall imaging and its accuracy in disclosing stenosis rate and plaque burden of carotid artery. METHODS: A total of 110 patients underwent contrast-enhanced CT scan with two phases, and BBCT images were obtained using contrast-enhancement (CE)-boost technology. Two radiologists independently scored subjective image quality on black-blood computerized tomography (BBCT) images using a 4-point scale and then further analyzed plaque types. The artery stenosis rate on BBCT was measured and compared with CTA. The plaque burden on BBCT was compared with that on high-resolution intracranial vessel wall MR imaging (VW-MR imaging). The kappa value and intraclass correlation coefficient (ICC) were used for consistency analysis. The diagnostic accuracy of BBCT for stenosis rate and plaque burden greater than 50% was evaluated by AUC. RESULTS: The subjective image quality scores of BBCT had good consistency between the two readers (ICC = 0.836, p < 0.001). BBCT and CTA had a good consistency in the identification of stenosis rate (p < 0.001). There was good consistency between BBCT and VW-MR in diagnosis of plaque burden (p < 0.001). As for plaque burden over 50%, BBCT had good sensitivity (93.10%) and specificity (73.33%), with an AUC of 0.950 (95%CI 0.838-0.993). Compared with CTA, BBCT had higher consistency with VW-MR in disclosing low-density plaques and mixed plaques (ICC = 0.931 vs 0.858, p < 0.001). CONCLUSIONS: BBCT can not only display the carotid artery wall clearly but also accurately diagnose the stenosis rate and plaque burden of carotid artery. CLINICAL RELEVANCE STATEMENT: Black-blood CT, as a novel imaging technology, can assist clinicians and radiologists in better visualizing the structure of the vessel wall and plaques, especially for patients with contraindication to MRI. KEY POINTS: • Black-blood CT can clearly visualize the carotid artery wall and plaque burden. • Black-blood CT is superior to conventional CTA with more accurate diagnosis of the carotid stenosis rate and plaque burden features.

Pericardial fat volume and coronary risk factors as predictors of non-calcified coronary plaque presence among patients with coronary calcium score = 0.

INTRODUCTION: There is scarce data linking pericardial fat volume (PFV) and classical coronary risk factors with non-calcified plaque presence among patients with CAC = 0 in the literature. MATERIAL AND METHOD: A total of 811 patients with chest pain suggestive of angina underwent CT coronary angiography for the assessment of coronary artery disease were collected. Of these, 417 with CAC = 0 were included in the analysis. RESULT: Patients with non-calcified plaque were older (54 ± 9 versus 50 ± 10, P = 0.01) and had a higher prevalence of diabetes mellitus (31% versus 17%, P = 0.02), high BMI (29.9 versus 28.3, P = 0.04), and increased PFV (123 cm3 versus 99 cm3, P < 0.01) compared to patients without plaque. In multivariate regression analysis, high BMI[OR(CI) = 1.1(1-1.3), P = 0.02] was an independent predictor of non-calcified coronary plaque presence among patients with CAC = 0 after adjustment to variables with P < 0.05 in the univariate analysis. CONCLUSION: In patients with a CAC score of 0, advanced age, diabetes mellitus, increased PFV, and high BMI were all associated with the presence of non-calcified plaque. After multivariate adjustment, increased BMI remained a significant independent predictor for non-calcified plaque presence.

Advancements in non-invasive imaging of atherosclerosis: Future perspectives.

Atherosclerosis is a chronic inflammatory disease characterized by the buildup of plaques in arterial walls, leading to cardiovascular diseases and high morbidity and mortality rates worldwide. Non-invasive imaging techniques play a crucial role in evaluating patients with suspected or established atherosclerosis. However, there is a growing body of evidence suggesting the need to visualize the underlying processes of plaque progression and rupture to enhance risk stratification. This review explores recent advancements in non-invasive assessment of atherosclerosis, focusing on computed tomography, magnetic resonance imaging, and nuclear imaging. These advancements provide valuable insights into the assessment and management of atherosclerosis, potentially leading to better risk stratification and improved patient outcomes.

Structural and Functional Disturbances of the Thoracic Aorta in Atherosclerosis of Various Gradations.

Aim      To study global aortic circumferential strain in normal conditions and in atherosclerosis of various grades and to determine its role in prediction of structural and functional disorders of the thoracic aorta (TA) and coronary atherosclerosis using 2D speckle-tracking transesophageal echocardiography.Material and methods  182 patients with typical or probable angina were examined. The control group consisted of 11 healthy volunteers. TA was visualized along its entire length. The height of each atheroma was measured, and the total number of plaques in the TA was determined. Five stages of TA atherosclerosis were identified. In the descending TA, the global peak systolic circumferential strain (GCS, %) and the global peak systolic circumferential strain normalized to pulse arterial pressure (PAP) (GCS / PAP∙100) were calculated. All patients underwent coronary angiography. The number of coronary arteries (CAs) with >50 % stenosis was determined, and the SYNTAX Score was calculated.Results TA atherosclerosis was not detected in the control group. Among 182 patients, stage 1-5 TA atherosclerosis was found in 23 (12.6 %), 103 (56.6 %), 43 (23.6 %), 7 (3.8 %), and 6 (3.4 %) cases respectively. GCS and GCS / PAD decreased as the ultrasound stage of TA atherosclerosis increased as compared with the control group: 9.2 % and 15.3 for the control group; stage 1, 5.6 % and 8.9 (p<0.001); stage 2, 4.1 % and 5.9 (p<0.001); stage 3, 4 % and 5.8 (p<0.001); stage 4, 3.7 % and 4.9 (p<0.01); and stage 5, 2.6 % and 3.3 (p<0.01), respectively. ROC analysis showed that GCS ≥5.9 % (area under the curve, AUC, 0.94±0.03; p<0.001) and GCS / PAD ≥11.4 (AUC, 0.97±0.02; p <0.001) were predictors of intact TA. Also, GCS ≤4.85 % (AUC, 0.82±0.04; p<0.001) and GCS / PAD ≤8.06 (AUC, 0.87±0.03; p<0.001) were predictors of hemodynamically significant TA atherosclerosis (stages 3-5). GCS ≤4.05 % (AUC, 0.62±0.04; p=0.007) and GCS / PAD ≤5.95 (AUC, 0.61±0.04; p=0.018) were predictors of hemodynamically significant (>50 %) stenosing atherosclerosis of at least one CA. Furthermore, GCS ≤3.75 % (AUC, 0.67±0.07; p=0.039) and GCS / PAD ≤5.15 (AUC, 0.64±0.07; p=0.045) were predictors of severe and advanced coronary atherosclerosis (SYNTAX Score ≥22).Conclusion      GCS and GCS / PAD are new diagnostic markers of structural and functional disorders of TA in atherosclerosis of various grades. GCS and GCS / PAD are independent predictors of high-grade TA atherosclerosis (stages 3-5) with GCS / PAD demonstrating the highest level of significance. GCS and GCS / PAD are non-invasive predictors of severe and advanced CA atherosclerosis.

Accurate adventitia reconstruction; significant or not in atherosclerotic plaque growth simulationsƒ A comparative study.

A reform in the diagnosis and treatment process is urgently required as carotid artery disease remains a leading cause of death in the world. To this purpose, all computational techniques are now being applied to enhancing the most cutting-edge diagnosis techniques. Computational modeling of plaque generation and evolution is being refined over the past years to forecast the atherosclerotic progression and the corresponding risk in patient-specific carotid arteries. A prerequisite to their implementation is the reconstruction of the precise three-dimensional models of patient-specific main carotid arteries. Even with the most sophisticated algorithms, accurate reconstruction of the arterial vessel is frequently difficult. Furthermore, there are several works of plaque growth modeling that ignore the reconstruction of the artery's outer layer in favor of a virtual one. In this paper, we investigate the importance of an accurate adventitia layer in plaque growth modeling. This is done as a comparative study by implementing a novel plaque growth model in two reconstructed carotid arterial segments using either their realistic or virtual adventitia layer as input. The results indicate that accurate adventitia reconstruction is of minor importance regarding species distributions and plaque growth in carotid segments, which initially did not contain any plaque regions.Clinical Relevance- The findings of this comparative study emphasize the importance of precise adventitia geometry in plaque growth modeling. As a result, this work sets a higher standard for publishing new plaque growth models.

Determination of lipid-rich plaques by artificial intelligence-enabled quantitative computed tomography using near-infrared spectroscopy as reference.

BACKGROUND AND AIMS: Artificial intelligence quantitative CT (AI-QCT) determines coronary plaque morphology with high efficiency and accuracy. Yet, its performance to quantify lipid-rich plaque remains unclear. This study investigated the performance of AI-QCT for the detection of low-density noncalcified plaque (LD-NCP) using near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS). METHODS: The INVICTUS Registry is a multi-center registry enrolling patients undergoing clinically indicated coronary CT angiography and IVUS, NIRS-IVUS, or optical coherence tomography. We assessed the performance of various Hounsfield unit (HU) and volume thresholds of LD-NCP using maxLCBI4mm ≥ 400 as the reference standard and the correlation of the vessel area, lumen area, plaque burden, and lesion length between AI-QCT and IVUS. RESULTS: This study included 133 atherosclerotic plaques from 47 patients who underwent coronary CT angiography and NIRS-IVUS The area under the curve of LD-NCP<30HU was 0.97 (95% confidence interval [CI]: 0.93-1.00] with an optimal volume threshold of 2.30 mm3. Accuracy, sensitivity, and specificity were 94% (95% CI: 88-96%], 93% (95% CI: 76-98%), and 94% (95% CI: 88-98%), respectively, using <30 HU and 2.3 mm3, versus 42%, 100%, and 27% using <30 HU and >0 mm3 volume of LD-NCP (p < 0.001 for accuracy and specificity). AI-QCT strongly correlated with IVUS measurements; vessel area (r2 = 0.87), lumen area (r2 = 0.87), plaque burden (r2 = 0.78) and lesion length (r2 = 0.88), respectively. CONCLUSIONS: AI-QCT demonstrated excellent diagnostic performance in detecting significant LD-NCP using maxLCBI4mm ≥ 400 as the reference standard. Additionally, vessel area, lumen area, plaque burden, and lesion length derived from AI-QCT strongly correlated with respective IVUS measurements.

Oxidative stress biomarker triggered multiplexed tool for auxiliary diagnosis of atherosclerosis.

Oxidative stress is integral in the development of atherosclerosis, but knowledge of how oxidative stress affects atherosclerosis remains insufficient. Here, we design a multiplexed diagnostic tool that includes two functions (photoacoustic imaging and urinalysis), for assessing intraplaque and urinary malondialdehyde (MDA), a well-recognized end-product of oxidative stress. Molecular design is conducted to develop the first near-infrared MDA-responsive molecule (MRM). Acid-unlocked ratiometric photoacoustic nanoprobe is designed to report intraplaque MDA, enabling it to reflect plaque burden. Furthermore, MRM is tailored for urinary MDA detection with excellent specificity in a blind study. Moreover, we found a significant difference in urinary MDA between healthy adults and atherosclerotic patients (more than 600 participants). Combining these two functions, such a multiplexed diagnostic tool can dynamically report intraplaque and systemic oxidative stress levels during atherosclerosis progression, pneumonia infection, and drug treatment in atherosclerotic mice, which is promising for the auxiliary diagnosis of atherosclerosis.

Identifying and Treating Vulnerable Atherosclerotic Plaques.

Acute coronary syndromes and, in particular, ST-elevation myocardial infarction are usually caused by coronary thrombosis in which the thrombus develops either on a disrupted plaque (usually a thin-capped fibroatheroma) or an eroded atherosclerotic plaque. These thrombus-prone plaques are vulnerable or high-risk. Although, traditionally, cardiologists have concentrated on treating significant coronary obstruction, there has been great interest over the last 2 decades in possibly preventing the thrombotic causes of myocardial infarction/sudden coronary death by mostly identifying and stabilizing these asymptomatic vulnerable or high-risk plaques, which, at least on invasive angiography, are mostly nonobstructive. Computed tomographic angiography and intravascular imaging during invasive coronary angiography have now been shown to identify a majority of these vulnerable or high-risk plaques before symptoms, thus opening up new preventive strategies. In conclusion, this article discusses the identification and management of these thrombus-prone lesions and patients with these lesions either with noninvasive techniques and systemic therapies or possibly through a new and bold interventional paradigm.

Combining metabolomics and OCT to reveal plasma metabolic profiling and biomarkers of plaque erosion and plaque rupture in STEMI patients.

OBJECTIVE: Plaque erosion (PE) and plaque rupture (PR) are the main subtypes of ST-segment elevation myocardial infarction (STEMI), the differences of metabolic patterns between PE and PR remain largely unknown. METHODS: 132 STEMI patients were divided into training set (PR, n = 36; PE, n = 36) and test set (PR, n = 30; PE, n = 30), the plasma from patients were analyzed by liquid chromatography quadruple time-of-flight mass spectrometry. RESULTS: We identified 56 and 28 differences in training and test set, respectively. Among these metabolites, it was found that docosahexaenoic acid (DHA), salicylic acid and proline were recognized in both tests. Receiver Operating Characteristic (ROC) analysis showed that the area under curve of docosahexaenoic acid (DHA) was 0.81 and 0.75 in training and test samples, respectively; proline was 0.67 and 0.74 in training and test samples, respectively; salicylic acid was 0.70 and 0.73 in training and test samples, respectively. CONCLUSIONS: DHA, salicylic acid, and proline could be used as non-invasive biomarkers to differentiate PE and PR.

Complementary Roles of Near-Infrared Spectroscopy and Intravascular Ultrasound in the Prediction of Periprocedural Myocardial Injury.

BACKGROUND: Lipid-rich plaque detected by near-infrared spectroscopy (NIRS) and attenuated plaque detected by intravascular ultrasound (IVUS) predict periprocedural myocardial injury (MI) following percutaneous coronary intervention (PCI). Although echolucent plaque detected by IVUS was reported to be associated with a no-reflow phenomenon in acute myocardial infarction, it remains unclear whether echolucent plaque is predictive of periprocedural MI following elective PCI. We aimed to elucidate whether echolucent plaque is independently associated with periprocedural MI after elective PCI and whether the predictive ability for periprocedural MI is improved by the combination of NIRS and IVUS. METHODS: This retrospective study included 121 lesions of 121 patients who underwent elective NIRS-IVUS-guided stent implantation. Periprocedural MI was defined as post-PCI cardiac troponin T > 70 ng/L. A maximum 4-mm lipid core burden index > 457 was regarded as lipid-rich plaque. Echolucent plaque was defined as the presence on IVUS of an echolucent zone and attenuated plaque as an attenuation arc > 90°. RESULTS: Periprocedural MI occurred in 39 lesions. In multivariable analysis, echolucent plaque, attenuated plaque, and lipid-rich plaque were independent predictors of periprocedural MI. Adding echolucent plaque and attenuated plaque to lipid-rich plaque improved the predictive performance (C statistic 0.825 vs 0.688; P = 0.001). Periprocedural MI increased with the number of predictors: 3% [1/39], 29% [10/34], 47% [14/30], and 78% [14/18] for 0, 1, 2, and 3 predictors, respectively (P < 0.001). CONCLUSIONS: Echolucent plaque is a major predictor of periprocedural MI, independently from lipid-rich plaque and attenuated plaque. Compared with NIRS alone, the combination of NIRS with IVUS signatures improves the predictive ability.

Irisin as a Novel Biomarker of Subclinical Atherosclerosis in Severe Obesity.

Severe obesity (SO) can accelerate atherosclerosis and the onset of acute cardiovascular events. The diagnosis of atherosclerosis in the context of a high body mass index (BMI) can be challenging, making the identification of biomarkers clinically relevant. We aimed to assess the usefulness of irisin as a biomarker for subclinical atherosclerosis in participants with SO. This prospective observational study included 61 participants undergoing bariatric surgery for SO, defined as a BMI >40 kg/m2 or >35 kg/m2 with at least one comorbidity. Atherosclerotic plaques were detected by ultrasound. Plasma samples were obtained 1 month before and at 6 and 12 months after bariatric surgery to measure irisin by ELISA. Additionally, subcutaneous samples of adipose tissue were taken and genotyped to identify irisin polymorphism rs3480. Irisin levels were positively correlated with BMI (r = 0.23, p = 0.0064), negatively correlated with atheroma-related parameters (e.g., carotid intima-media thickness), and lower in subjects with atheroma (p < 0.0002). Irisin also showed good overall accuracy for discriminating plaque presence (AUC, 0.81; 95% CI, 0.6956-0.9156). However, the rs3480 polymorphism correlated with neither the irisin levels nor the presence of atheromas. Iirisin could identify subclinical atherosclerosis in SO and might facilitate clinical diagnosis.

Coronary Computed Tomography Angiography Findings of Plaque Erosion.

Compared with plaque rupture, plaque erosion has distinct features, which can be diagnosed only by intravascular optical coherence tomography. Computed tomography angiography (CTA) features of plaque erosion have not been reported. The aim of the present study was to identify the CTA features specific for plaque erosion in patients with non-ST-segment elevation acute coronary syndromes to enable a diagnosis of erosion without invasive procedures. Patients with non-ST-segment elevation acute coronary syndromes who underwent preintervention CTA and optical coherence tomography imaging of culprit lesions were enrolled. Plaque volume and high-risk plaque (HRP) features were assessed by CTA. Among 191 patients, plaque erosion was the underlying mechanism in 89 patients (46.6%) and plaque rupture in 102 patients (53.4%). The total plaque volume (TPV) was lower in plaque erosion than in plaque rupture (133.6 vs 168.8 mm3, p = 0.001). Plaque erosion had a lower prevalence of positive remodeling than plaque rupture (75.3% vs 87.3%, p = 0.033). As the number of HRP features decreased, plaque erosion became more prevalent (p = 0.014). In the multivariable logistic regression analysis, lower TPV and less prevalent HRP features were associated with a higher prevalence of plaque erosion. The addition of TPV ≤116 mm3 and HRP features ≤1 to the known predictors significantly increased the area under the curve of the plaque erosion prediction receiver operator characteristics. Plaque erosion, compared with plaque rupture, had a lower plaque volume and less prevalent HRP features. CTA may be helpful for identifying the underlying pathology of acute coronary syndromes.

Pearls and Pitfalls of Carotid Artery Imaging: Ultrasound, Computed Tomography Angiography, and MR Imaging.

Stroke represents a major cause of morbidity and mortality worldwide with carotid atherosclerosis responsible for a large proportion of ischemic strokes. Given the high burden of the disease , early diagnosis and optimal secondary prevention are essential elements in clinical practice. For a long time, the degree of stenosis had been considered the parameter to judge the severity of carotid atherosclerosis. Over the last 30 years, literature has shifted attention from stenosis to structural characteristics of atherosclerotic lesion, eventually leading to the "vulnerable plaque" model. These "vulnerable plaques" frequently demonstrate high-risk imaging features that can be assessed by various non-invasive imaging modalities.

Atherosclerotic carotid plaque characteristics vary with time from ischemic event: A multicenter, prospective magnetic resonance vessel wall imaging registry study.

Recent studies report that the rate of recurrent stroke is highest in the stages immediately following cerebral infarction and decreases over time in patients with atherosclerotic carotid stenosis. The purpose of this study was to identify temporal differences in early stage carotid plaque components from acute cerebrovascular ischemic events using carotid MRI. Carotid plaque images were obtained on 3 T MRI from 128 patients enrolled in MR-CAS. Among the 128 subjects, 53 were symptomatic and 75 asymptomatic. The symptomatic patients were classified into three groups based on interval from onset of symptoms to the date of the carotid MRI (Group <14 days; 15-30 days; and > 30 days). The volume of each plaque component was identified and quantified from MR images. The presence of juxtaluminal loose matrix/inflammation (LM/I) was identified as a possible indicator of inflammation on the luminal side. Plaque components were compared between groups using the Wilcoxon rank-sum or the Chi-square test. Patient characteristics and carotid plaque morphology were similar among all four groups. The median volume of LM/I in Group >30 days was significantly lower than in other groups (0 mm3 vs 12.3 mm3 and 18.1 mm3; p = 0.003). In addition, the prevalence of juxtaluminal LM/I decreased over time (ptrend = 0.002). There were no statistically significant differences in other plaque components between the symptomatic groups. The volume of LM/I was significantly smaller in Group >30 days and prevalence of juxtaluminal LM/I in the atherosclerotic carotid plaque was high in the early stages after events. This suggests that carotid plaques undergo rapid evolution after an acute cerebrovascular ischemic event.