Plaque At RISK (PARISK): prospective multicenter study to improve diagnosis of high-risk carotid plaques
M T B Truijman1, M E Kooi, A C van Dijk
1Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands.
Insights
Assessing carotid plaque characteristics using advanced imaging may identify patients with less than 70% stenosis at high risk for recurrent stroke. This aids in selecting appropriate candidates for carotid endarterectomy.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Symptomatic carotid artery stenosis poses a high risk for recurrent stroke.
- Current stroke risk assessment relies heavily on stenosis degree, potentially missing critical plaque details.
- Identifying specific plaque characteristics can refine patient selection for interventions like carotid endarterectomy.
Purpose of the Study:
- To evaluate if advanced imaging techniques can identify patients with <70% carotid artery stenosis at increased risk of stroke.
- To explore the utility of magnetic resonance imaging (MRI), computed tomography angiography (CTA), ultrasonography, and transcranial Doppler (TCD) in assessing carotid plaque.
- To determine if combined imaging modalities improve risk stratification for recurrent stroke.
Main Methods:
- Prospective multicenter cohort study (Plaque At RISK - PARISK study).
- Inclusion of 300 patients with recent neurological symptoms and <70% ipsilateral carotid stenosis.
- Baseline and follow-up imaging (MRI, CTA, ultrasonography, TCD) and clinical follow-up over two years.
Main Results:
- The primary endpoint combines ipsilateral recurrent ischemic stroke, transient ischemic attack, or new ischemic brain lesions on follow-up MRI.
- Analysis will focus on correlating plaque characteristics with clinical outcomes.
- The study aims to identify imaging biomarkers for stroke risk.
Conclusions:
- Advanced imaging of carotid plaque characteristics holds promise for improved stroke risk prediction.
- This approach may enable more personalized treatment decisions for patients with carotid artery stenosis.
- The PARISK study will provide crucial data on the role of plaque imaging in stroke prevention.
Background:
Patients with symptomatic carotid artery stenosis are at high risk for recurrent stroke. To date, the decision to perform carotid endarterectomy in patients with a recent cerebrovascular event is mainly based on degree of stenosis of the ipsilateral carotid artery. However, additional atherosclerotic plaque characteristics might be better predictors of stroke, allowing for more precise selection of patients for carotid endarterectomy.
Aims And Hypothesis:
We investigate the hypothesis that the assessment of carotid plaque characteristics with magnetic resonance imaging, multidetector-row computed tomography angiography, ultrasonography, and transcranial Doppler, either alone or in combination, may improve identification of a subgroup of patients with < 70% carotid artery stenosis with an increased risk of recurrent stroke.
Methods:
The Plaque At RISK (PARISK) study is a prospective multicenter cohort study of patients with recent (<3 months) neurological symptoms due to ischemia in the territory of the carotid artery and < 70% ipsilateral carotid artery stenosis who are not scheduled for carotid endarterectomy or stenting. At baseline, 300 patients will undergo magnetic resonance imaging, multidetector-row computed tomography angiography, and ultrasonography examination of the carotid arteries. In addition, magnetic resonance imaging of the brain, ambulatory transcranial Doppler recording of the middle cerebral artery and blood withdrawal will be performed. After two-years, imaging will be repeated in 150 patients. All patients undergo a follow-up brain magnetic resonance imaging, and there will be regular clinical follow-up until the end of the study.
Study Outcomes:
The combined primary end-point contains ipsilateral recurrent ischemic stroke or transient ischemic attack or new ipsilateral ischemic brain lesions on follow-up brain magnetic resonance imaging.
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