# MRI Detection of CarotId Plaques as a mecHanism for Embolic strokes of undeteRmined source (MRI DECIPHER)

> **NIH NIH R01** · WEILL MEDICAL COLL OF CORNELL UNIV · 2020 · $815,480

## Abstract

PROJECT SUMMARY/ABSTRACT
 In one-third of strokes, a definite cause cannot be established. This proposal seeks to determine if
some of these strokes in fact resulted from unrecognized atherosclerotic plaque in the arteries leading to the
brain. Currently, only atherosclerotic plaques that cause significant stenosis (narrowing) of an artery are
treated as the underlying cause of a stroke. However, pilot data suggest that nonstenosing plaques—plaques
that have not caused arterial narrowing—can rupture and produce clots that travel downstream to block blood
flow to the brain. Magnetic resonance imaging (MRI) can reliably determine which plaques have the highest
risk of rupture. Such markers can identify high-risk nonstenosing plaques in the internal carotid arteries, which
supply the majority of the brain's blood flow. In a patient with a stroke of unknown cause, pilot studies have
found that the stroke is more likely to have occurred on the side of a carotid artery with high-risk nonstenosing
plaque than on the opposite side where no high-risk plaque is present. The tendency of strokes to occur
downstream of a high-risk nonstenosing plaque supports this application's hypothesis: that atherosclerotic
plaque in the cerebral circulation is associated with stroke even in the absence of significant arterial narrowing.
Such nonstenosing plaques may explain a substantial proportion of strokes whose cause currently seems
unknown. Better recognition of these plaques may lead to better stroke prevention. Prior clinical trials found
that carotid endarterectomy/stenting was not effective for preventing stroke recurrence in patients with
nonstenosing plaque, and such plaques are now ignored in clinical practice. However, no trial has tested
carotid endarterectomy/stenting in only those stroke patients whose nonstenosing plaque entails a stroke
recurrence risk high enough that the benefits of the procedure outweigh its risks. If successful, the research
proposed in this application would identify a novel stroke risk factor and establish the scientific premise for a
potentially transformative therapeutic strategy. This application is for a prospective observational study of 200
patients with stroke of unknown cause. A detailed MRI protocol will be used to detect intraplaque hemorrhage,
a marker of high-risk nonstenosing plaque. In 150 of the subjects, a PET/MRI study will also be performed for
additional insight into high-risk features such as plaque inflammation. Aim 1 will test the hypothesis that brain
infarcts will be more common on the side of a high-risk nonstenosing plaque than the opposite side. Aim 2 will
test the hypothesis that in-depth stroke evaluation will less often uncover an alternative explanation in subjects
with high-risk nonstenosing plaque than in those without such plaques. Aim 3 will test the hypothesis that
recurrent infarction will occur more often on the same side as high-risk nonstenosing plaque than on the
opposite side. Validation of...

## Key facts

- **NIH application ID:** 9993563
- **Project number:** 5R01HL144541-02
- **Recipient organization:** WEILL MEDICAL COLL OF CORNELL UNIV
- **Principal Investigator:** Ajay Gupta
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $815,480
- **Award type:** 5
- **Project period:** 2019-08-15 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9993563

## Citation

> US National Institutes of Health, RePORTER application 9993563, MRI Detection of CarotId Plaques as a mecHanism for Embolic strokes of undeteRmined source (MRI DECIPHER) (5R01HL144541-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9993563. Licensed CC0.

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