Calcified carotid plaques more likely to rupture than previously believed, MRI findings suggest
Over time, calcified carotid plaque may undergo changes that present risk to patients, even in those who don’t have symptoms, new MRI data suggest.
Atherosclerotic plaques harden over time, which causes them to become more stable. It has long been believed that this process of calcification reduces the risk of plaques rupturing, which could cause the formation of blood clots that have the potential to reach the brain. This latest research, however, questions that notion; MRI findings from the study indicate that even calcified plaques have the potential to rupture.
“It is important to remember that plaques that don’t yet cause symptoms can rapidly evolve in ways that make them more dangerous,” study author Daniel Bos, MD, PhD, an associate professor in Clinical Epidemiology and Neurovascular Imaging at Erasmus MC at University Medical Center Rotterdam in the Netherlands, said in a news release on the findings. “One of the key findings of our work is that calcified plaques may not be as harmless as once thought, since these plaques were found to be at risk of intraplaque bleeding, which in itself is the most important cause of plaque rupture and subsequent stroke.”
For the study, researchers analyzed data from 802 patients ages 45 and older who had the confirmed presence of subclinical carotid artery atherosclerosis. Each had two MRIs to evaluate plaque composition—one baseline and one six years after their initial diagnosis. None of the patients were symptomatic.
The team found that the plaques’ composition changed significantly throughout the study period; some calcified, while some started to bleed and others developed fatty deposits. Calcified plaques were twice as likely to develop internal bleeding compared to those that had not hardened. This is concerning, as this sort of bleeding makes plaques more susceptible to rupture and, therefore, stroke, the group cautioned.
“Understanding this evolution could help doctors better predict stroke risk,” Bos suggested. “Even if there are no symptoms, early signs of plaque in your carotid arteries can quietly become more dangerous over time. Regular check-ups and managing risk factors like blood pressure, cholesterol, smoking and diabetes are important, because plaque changes can happen without warning.”
Learn more about the team’s findings here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.