• 1
    Rothwell PM, Eliasziw M, Gutnikov SA, et al. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 2003;361:107116.
  • 2
    National Institute for Health and Clinical Excellence. Clinical guideline 68: Stroke. Urgent carotid endarterectomy and carotid stenting. July 2008 ed. Available at:
  • 3
    Eliasziw M, Kennedy J, Hill MD, et al. Early risk of stroke after a transient ischemic attack in patients with internal carotid artery disease. CMAJ 2004;170:11051109.
  • 4
    Fairhead JF, Mehta Z, Rothwell PM. Population-based study of delays in carotid imaging and surgery and the risk of recurrent stroke. Neurology 2005;65:371375.
  • 5
    Naylor AR. What is the current status of invasive treatment of extracranial carotid artery disease? Stroke 2011;42:20802085.
  • 6
    Rothwell PM, Giles MF, Chandratheva A, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet 2007;370:14321442.
  • 7
    Brott TG, Halperin JL, Abbara S, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. J Am Coll Cardiol 2011;57:e16e94.
  • 8
    King A, Markus HS. Doppler embolic signals in cerebrovascular disease and prediction of stroke risk: a systematic review and meta-analysis. Stroke 2009;40:37113717.
  • 9
    Redgrave JN, Lovett JK, Gallagher PJ, Rothwell PM. Histological assessment of 526 symptomatic carotid plaques in relation to the nature and timing of ischemic symptoms: the Oxford plaque study. Circulation 2006;113:23202328.
  • 10
    Falk E. Morphologic features of unstable atherothrombotic plaques underlying acute coronary syndromes. Am J Cardiol 1989;63:114E120E.
  • 11
    Kolodgie FD, Gold HK, Burke AP, et al. Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med 2003;349:23162325.
  • 12
    Saam T, Ferguson MS, Yarnykh VL, et al. Quantitative evaluation of carotid plaque composition by in vivo MRI. Arterioscler Thromb Vasc Biol 2005;25:234239.
  • 13
    Moody AR, Murphy RE, Morgan PS, et al. Characterization of complicated carotid plaque with magnetic resonance direct thrombus imaging in patients with cerebral ischemia. Circulation 2003;107:30473052.
  • 14
    Chu B, Kampschulte A, Ferguson MS, et al. Hemorrhage in the atherosclerotic carotid plaque: a high-resolution MRI study. Stroke 2004;35:10791084.
  • 15
    Bitar R, Moody AR, Leung G, et al. In vivo 3D high-spatial-resolution MR imaging of intraplaque hemorrhage. Radiology 2008;249:259267.
  • 16
    Altaf N, Akwei S, Auer DP, et al. Magnetic resonance detected carotid plaque haemorrhage is associated with inflammatory features in symptomatic carotid plaques. Ann Vasc Surg (in press).
  • 17
    Murphy RE, Moody AR, Morgan PS, et al. Prevalence of complicated carotid atheroma as detected by magnetic resonance direct thrombus imaging in patients with suspected carotid artery stenosis and previous acute cerebral ischemia. Circulation 2003;107:30533058.
  • 18
    Turc G, Oppenheim C, Naggara O, et al. Relationships between recent intraplaque hemorrhage and stroke risk factors in patients with carotid stenosis: the HIRISC study. Arterioscler Thromb Vasc Biol 2012;32:492499.
  • 19
    Yamada N, Higashi M, Otsubo R, et al. Association between signal hyperintensity on T1-weighted MR imaging of carotid plaques and ipsilateral ischemic events. AJNR Am J Neuroradiol 2007;28:287292.
  • 20
    Parmar JP, Rogers WJ, Mugler JP III, et al. Magnetic resonance imaging of carotid atherosclerotic plaque in clinically suspected acute transient ischemic attack and acute ischemic stroke. Circulation 2010;122:20312038.
  • 21
    Demarco JK, Ota H, Underhill HR, et al. MR carotid plaque imaging and contrast-enhanced MR angiography identifies lesions associated with recent ipsilateral thromboembolic symptoms: an in vivo study at 3T. AJNR Am J Neuroradiol 2010;31:13951402.
  • 22
    Altaf N, Morgan PS, Moody A, et al. Brain white matter hyperintensities are associated with carotid intraplaque hemorrhage. Radiology 2008;248:202209.
  • 23
    Altaf N, Goode SD, Beech A, et al. Plaque hemorrhage is a marker of thromboembolic activity in patients with symptomatic carotid disease. Radiology 2011;258:538545.
  • 24
    Lin K, Zhang ZQ, Detrano R, et al. Carotid vulnerable lesions are related to accelerated recurrence for cerebral infarction magnetic resonance imaging study. Acad Radiol 2006;13:11801186.
  • 25
    Underhill HR, Yuan C, Yarnykh VL, et al. Arterial remodeling in [corrected] subclinical carotid artery disease. JACC Cardiovasc Imaging 2009;2:13811389.
  • 26
    Takaya N, Yuan C, Chu B, et al. Presence of intraplaque hemorrhage stimulates progression of carotid atherosclerotic plaques: a high-resolution magnetic resonance imaging study. Circulation 2005;111:27682775.
  • 27
    Altaf N, Beech A, Goode SD, et al. Carotid intraplaque hemorrhage detected by magnetic resonance imaging predicts embolization during carotid endarterectomy. J Vasc Surg 2007;46:3136.
  • 28
    Teng Z, Sadat U, Huang Y, et al. In vivo MRI-based 3D mechanical stress-strain profiles of carotid plaques with juxtaluminal plaque haemorrhage: an exploratory study for the mechanism of subsequent cerebrovascular events. Eur J Vasc Endovasc Surg 2011;42:427433.
  • 29
    Takaya N, Yuan C, Chu B, et al. Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRI—initial results. Stroke 2006;37:818823.
  • 30
    Altaf N, MacSweeney ST, Gladman J, Auer DP. Carotid intraplaque hemorrhage predicts recurrent symptoms in patients with high-grade carotid stenosis. Stroke 2007;38:16331635.
  • 31
    Altaf N, Daniels L, Morgan PS, et al. Detection of intraplaque hemorrhage by magnetic resonance imaging in symptomatic patients with mild to moderate carotid stenosis predicts recurrent neurological events. J Vasc Surg 2008;47:337342.
  • 32
    Singh N, Moody AR, Gladstone DJ, et al. Moderate carotid artery stenosis: MR imaging-depicted intraplaque hemorrhage predicts risk of cerebrovascular ischemic events in asymptomatic men. Radiology 2009;252:502508.
  • 33
    Kurosaki Y, Yoshida K, Endo H, et al. Association between carotid atherosclerosis plaque with high signal intensity on T1-weighted imaging and subsequent ipsilateral ischemic events. Neurosurgery 2011;68:6267; discussion 67.
  • 34
    Yoshida K, Sadamasa N, Narumi O, et al. Symptomatic low-grade carotid stenosis with intraplaque hemorrhage and expansive arterial remodeling is associated with a high relapse rate refractory to medical treatment. 2012;70:11431150; discussion 1150–1151.
  • 35
    Kandiyil N, Altaf N, Hosseini AA, et al. Lower prevalence of carotid plaque hemorrhage in women, and its mediator effect on sex differences in recurrent cerebrovascular events. PLoS One 2012;7:e47319.
  • 36
    McCabe DJ, Pereira AC, Clifton A, et al. Restenosis after carotid angioplasty, stenting, or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS). Stroke 2005;36:281286.
  • 37
    DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177188.
  • 38
    Hellings WE, Peeters W, Moll FL, et al. Composition of carotid atherosclerotic plaque is associated with cardiovascular outcome: a prognostic study. Circulation 2010;121:19411950.
  • 39
    Kwee RM, van Oostenbrugge RJ, Mess WH, et al. Carotid plaques in transient ischemic attack and stroke patients: one-year follow-up study by magnetic resonance imaging. Invest Radiol 2010;45:803809.
  • 40
    Chu B, Yuan C, Takaya N, et al. Images in cardiovascular medicine. Serial high-spatial-resolution, multisequence magnetic resonance imaging studies identify fibrous cap rupture and penetrating ulcer into carotid atherosclerotic plaque. Circulation 2006;113:e660e661.
  • 41
    Redgrave JN, Lovett JK, Rothwell PM. Histological features of symptomatic carotid plaques in relation to age and smoking: the Oxford Plaque Study. Stroke 2010;41:22882294.
  • 42
    Rothwell PM, Gibson RJ, Slattery J, et al. Equivalence of measurements of carotid stenosis. A comparison of three methods on 1001 angiograms. European Carotid Surgery Trialists' Collaborative Group. Stroke 1994;25:24352439.
  • 43
    Cappendijk VC, Cleutjens KB, Heeneman S, et al. In vivo detection of hemorrhage in human atherosclerotic plaques with magnetic resonance imaging. J Magn Reson Imaging 2004;20:105110.
  • 44
    Zhao X, Underhill HR, Zhao Q, et al. Discriminating carotid atherosclerotic lesion severity by luminal stenosis and plaque burden: a comparison utilizing high-resolution magnetic resonance imaging at 3.0 Tesla. Stroke 2011;42:347353.
  • 45
    Cheung HM, Moody AR, Singh N, et al. Late stage complicated atheroma in low-grade stenotic carotid disease: MR imaging depiction—prevalence and risk factors. Radiology 2011;260:841847.
  • 46
    Rothwell PM, Eliasziw M, Gutnikov SA, et al. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 2004;363:915924.
  • 47
    Markus HS, MacKinnon A. Asymptomatic embolization detected by Doppler ultrasound predicts stroke risk in symptomatic carotid artery stenosis. Stroke 2005;36:971975.
  • 48
    Brott TG, Hobson RW Jr, Howard G, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 2010;363:1123.
  • 49
    Stroke Programme Clinical Standards Department. UK audit of vascular surgical services and carotid endarterectomy. London, UK: Royal College of Physicians of London, 2010.