Black Holes in Brain- Is There Any Relationship between Carotid Artery Plaque Type and Cerebral Micro Bleed? - Cohort from Pakistan

Purpose of Study: The purpose of this study is to correlate the presence of chronic micro bleed, patient symptoms, number of chronic micro bleeds and carotid plaque characteristics.

Materials and Methods: Seventy consecutive patients (50 men, 20 women; mean age 64.5; range 45-82 years) were selected for the study. We took every patient’s ipsilateral internal carotid artery and cerebral hemisphere individually. Each patient underwent MRI brain with stroke protocol and ultrasound carotid Doppler for suspected carotid pathology. Chronic micro bleeds were classified by an ordinal scale and carotid plaques were characterized based on their composition, that is, fatty, mixed, or calcified. Patients were classified as symptomatic and asymptomatic. Receiver operating characteristic (ROC) curve were created. Correlation was done to see association between the number of chronic micro bleeds, their symptoms and relationship of plaque type with chronic micro bleeds.

Results: The prevalence of chronic micro bleed was 42.8% (60/140) over all, with prevalence of 61.53% in symptomatic sides. A statistically significant difference between chronic micro bleeds presence was observed, with a P value of <0.0001 and an Odds ratio of 4.4 with 95% confidence interval of range 2.15 to 8.99.

Statistically significant direct correlation with the fatty / soft plaques (correlation coefficient = 0.177; P value = 0.018). No statistically significant association was detected between CMBs and mixed plaque type (correlation coefficient 0.090; P value .145). We also performed the ROC curve analysis for symptomatic (stroke and TIA) and asymptomatic sides and the results were: 0.7849 and 0.6181 respectively, confirming that there is an association between CMBs and symptomatic (stroke/TIA) patients, but no association between CMBs and asymptomatic patients.

Conclusion: This study shows there is increasing trend of chronic micro bleeds with fatty plaques. Moreover, chronic micro bleeds are prevalent in patients who have stroke or transient ischemic attacks.