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Background The relationship between the prevalence of intraplaque hemorrhage and degree of carotid artery stenosis has not been well established. It is unclear whether there is a threshold of stenosis/plaque progression during which plaque hemorrhage develops within an atherosclerotic lesion. Methods In this study, we reviewed our institutional case series of patients with carotid plaque imaging and reported on the prevalence of plaque hemorrhage based on degree of stenosis as well as symptomatic status. Results The presence of plaque hemorrhage was independent of degree of stenosis. This was true among both asymptomatic carotid arteries (P=0.31) and symptomatic carotid arteries (P=0.11). For arteries with severe stenosis, there was no difference in prevalence of plaque hemorrhage among symptomatic and asymptomatic patients (22/69 versus 10/40, P=0.52). However, for arteries with moderate stenosis (30–69%) the prevalence of plaque hemorrhage was significantly higher among symptomatic arteries versus asymptomatic (31/69 versus 10/66, P=0.0002). The same was true for patients with no stenosis (17/176 versus 6/504, P Conclusions The presence of plaque hemorrhage is independent from the degree of carotid artery stenosis. Carotid Plaque Imaging for detection of plaque hemorrhage is likely most helpful in identifying symptomatic lesions among patients with Disclosures A. Larson: None. J. Benson: None. G. Lanzino: None. W. Brinjikji: None.

Background Intraplaque hemorrhage (IPH) has been shown to be a predictor of symptomatic carotid artery disease, independent of degree of carotid stenosis. The association between modifiable cardiovascular risk factors, demographics and lab values has not been extensively studied. Methods We reviewed our institutional series of patients who have undergone dedicated carotid plaque imaging over a 3-year period and report the association between various demographic and clinical variables and the presence of plaque hemorrhage. Patients with dedicated carotid plaque imaging were categorized into two groups: those with IPH and those without. Results 643 total patients were reviewed. 114 patients (17.7%) had intraplaque hemorrhage on carotid plaque imaging sequences compared to 529 patients (82.3%) without. Patients with IPH had a mean age of 76.0 years compared to 60.1 years in those without IPH (P≤0.0001). 79% of patients with IPH were male, compared to 49.5% without IPH (P≤0.0001). 39.5% of patients with IPH had coronary artery disease compared to 23.1% of patients without IPH (P=0.0003). The IPH group also had higher proportions of patients with hypertension (77.2% vs. 60.7%, P=0.009), hyperlipidemia (89.5% vs. 62.4%, P≤0.0001), diabetes mellitus (89.5% vs. 62.4%, P=0.01) and a history of tobacco smoking (63.2% vs. 52.6%, P=0.003) as compared those without IPH. Conclusions IPH is associated with well-known non-modifiable and modifiable cardiovascular risk factors. Patients with these risk factors are therefore more likely to have IPH within carotid plaques as compared to patients without these risk factors. These factors likely play a role in IPH pathophysiology. Consideration of such risk factors is important in considering patients to be at risk for ischemic stroke from carotid plaque. Disclosures A. Larson: None. J. Benson: None. G. Lanzino: None. W. Brinjikji: None.

Background Ischemic stroke is more often diagnosed in the left hemisphere than the right. One prior study has found that there may be an asymmetrical prevalence of atherosclerosis with a higher prevalence of carotid artery disease on the left than the right. Methods We sought to study the prevalence of carotid artery atherosclerosis and intraplaque hemorrhage in the right versus left carotid artery in a large population of patients. Results Neck MRAs of 643 total patients were reviewed. Overall, there were similar degrees and distribution of degrees of stenosis. There was a higher prevalence of intraplaque hemorrhage in the left versus right carotid for all patients (P=0.02) and for symptomatic patients (P=0.002). This was not true for asymptomatic patients. There were no differences in the prevalence of plaque ulcer between right and left carotid arteries. Conclusions In confirming a prior report, we found that left carotids are more likely to present with intraplaque hemorrhage as compared to right carotids. This was particularly true for patients with symptomatic manifestations including stroke, transient ischemic attack, amaurosis fugax and retinal artery occlusion. The reason underlying the increased prevalence of intraplaque hemorrhage in the left carotid artery remains enigmatic. Disclosures A. Larson: None. J. Benson: None. G. Lanzino: None. W. Brinjikji: None.