Chinese Atherosclerosis Risk Evaluation(CARE II)study:a novel cross-sectional,multicentre study of the prevalence of high-risk atherosclerotic carotid plaque in Chinese patients with ischaemic cerebrovascular events-design and rationale

Background:Carotid atherosclerotic plaque is identified as one of the main sources of ischaemic stroke.However,the prevalence of carotid high-risk atherosclerotic plaque in Chinese patients with ischaemic cerebrovascular events has been inconsistently reported and needs to be investigated in a large population.Objectives:The primary objective of CARE II study was to determine the prevalence and characteristics of high-risk features of atherosclerotic plaques in the carotid arteries in Chinese patients with recent ischaemic stroke or transient ischaemia attack(TIA).The relationship between carotid plaque features and cerebral infarcts,the differences of carotid plaque patterns among different regions of China and the gender specific characteristics of carotid plaque will be also determined.Study design:The CARE II study will enrol 1000 patients with recent ischaemic stroke or TIA and carotid plaque from 13 hospitals and medical centres across China.In this cross-sectional,non-randomised,observational,multicentre study,all patients will undergo carotid artery MRI of bilateral carotid arteries and routine brain MRI with standardised protocols.The MRI will be interpreted at core reading centres to evaluate the characteristics of morphology and compositions of carotid plaque.Conclusions:This is a cross-sectional,multicentre study to investigate the prevalence and characteristics of high-risk atherosclerotic carotid plaque in Chinese patients with stroke and TIA by using high-resolution MRI of vessel wall.This trial is sufficiently powered to demonstrate the prevalence of carotid high-risk plaque and to explore regional differences in Chinese patients who suffered stroke.

Differences in atheroma between Caucasian and Asian subjects with anterior stroke:A vessel wall MRI study

Background and purpose While extracranial carotid artery stenosis is more common among Caucasians and intracranial artery stenosis is more common among Asians,the differences in atherosclerotic plaque characteristics have not yet been extensively examined.We sought to investigate plaque location and characteristics within extracranial carotid and intracranial arteries in symptomatic Caucasians and Chinese using vessel wall MRI.Methods Subjects with recent anterior circulation ischaemic stroke were recruited and imaged at two sites in the USA and China using similar protocols.Both extracranial carotid and intracranial arteries were reviewed to determine plaque location and characteristics.Results The prevalence of extracranial carotid plaque in Caucasians and Chinese was 73.1%and 49.1%,respectively(p=0.055).Prevalence of intracranial plaque was 38.5%and 69.1%in Caucasians and Chinese,respectively(p=0.02).Furthermore,42% of Caucasians and 16%of Chinese had high-risk plaque(HRP)features(intraplaque haemorrhage,luminal surface disruption)in the extracranial carotid artery(p=0.03).The prevalence of HRP features in intracranial arteries was not significantly different between the two cohorts(4%vs 11%;p=0.42).Conclusions Differences in the location and characteristics of cerebrovascular atherosclerosis were identified by vessel wall MRI in US Caucasian and Chinese subjects with recent anterior circulation ischaemic stroke.Extracranial carotid plaques with HRP features were more common in Caucasians.Intracranial plaques were more common in Chinese subjects,but no significant difference between the two cohorts in intracranial HRP prevalence was found.Larger studies using vessel wall imaging to investigate racial differences in cerebrovascular disease may inform underlying mechanisms of HRP development and may ultimately help guide appropriate therapy.