Prevalence of Ipsilateral Nonstenotic Carotid Plaques on Computed Tomography Angiography in Embolic Stroke of
Johanna M Ospel1,2, Nishita Singh, Martha Marko1
1From the Department of Clinical Neurosciences (J.M.O., M.A., A.D., S.B.C., M.D.H., B.K.M., M.G.), University of Calgary, Canada.
Insights
Nonstenotic carotid plaques, defined as <50% stenosis, were found more often on the stroke side in Embolic Stroke of Undetermined Source (ESUS) patients. These plaques may be a significant cause of stroke in ESUS.
Area of Science:
- Neurology
- Vascular Medicine
- Radiology
Background:
- Embolic Stroke of Undetermined Source (ESUS) accounts for a significant portion of ischemic strokes.
- Identifying specific causes in ESUS is vital for personalized secondary stroke prevention.
Purpose of the Study:
- To determine the prevalence of carotid plaques with <50% stenosis in ESUS patients using computed tomography angiography.
- To investigate the association between these nonstenotic carotid plaques and ipsilateral strokes.
Main Methods:
- Analysis of patients from the INTERRSeCT multicenter prospective study with acute ischemic stroke and neck CT angiography.
- Assessment of carotid plaque characteristics including stenosis degree, thickness, calcification, irregularity, ulceration, and hypodensity.
- Comparison of plaque prevalence and features between ESUS and non-ESUS patients, and association with ipsilateral stroke using logistic regression.
Main Results:
- Nonstenotic carotid plaques (<50% stenosis) were present in 39.1% of ESUS patients.
- These plaques were significantly more frequent on the ipsilateral side of the stroke (60.6%) compared to the contralateral side (P=0.004).
- Nonstenotic carotid plaques showed a significant association with ipsilateral strokes (adjusted odds ratio, 1.83).
Conclusions:
- Nonstenotic carotid plaques are more prevalent on the side of ischemic stroke in ESUS patients.
- These findings suggest that nonstenotic carotid plaques may represent an underrecognized cause of stroke in the ESUS population.
- Further research into nonstenotic plaques could refine stroke etiology classification and prevention strategies for ESUS.
Abstract:
Background and Purpose- Embolic stroke of undetermined source (ESUS) constitutes a large proportion of acute ischemic stroke. It is crucial to identify possible stroke etiologies in this patient subgroup to individually tailor secondary stroke prevention strategies. This study aimed to assess the prevalence of carotid plaques causing <50% stenosis in ESUS patients on computed tomography angiography and the association of these plaques with ipsilateral strokes. Methods- Patients from INTERRSeCT-a multicenter prospective study of patients with acute ischemic stroke-were included in this study if their stroke etiology was not large artery atherosclerosis (>50% stenosis), and neck computed tomography angiography was obtained. Degree of stenosis (<30% versus 30%-50%), maximum plaque thickness, degree of plaque calcification (<50% versus ≥50%), plaque irregularity, ulceration, hypodensity, carotid web, and focal vessel outpouching were assessed for both carotid arteries on computed tomography angiography. Prevalence of carotid plaques with <50% stenosis (nonstenotic plaques), ipsilateral and contralateral to the stroke, in ESUS patients was determined and compared with non-ESUS patients. Features of these plaques with versus without ipsilateral stroke in ESUS patients were compared. Uni- and multivariable logistic regression was performed to determine associations between nonstenotic carotid plaque, plaque characteristics, and ipsilateral stroke in ESUS patients. Results- Four hundred forty-six patients were included in the study (median age, 73 years; 218 men), 138 of which were ESUS patients (median age, 70 years; 61 men). Nonstenotic carotid plaques (with <50% stenosis) were present in 54 of 138 (39.1%) ESUS patients. Twelve (8.7%) patients had bilateral carotid plaques. Forty (60.6%) of these plaques were ipsilateral and 26 (39.4%) contralateral to the side of the stroke (P=0.004). Nonstenotic carotid plaques were significantly associated with ipsilateral strokes (adjusted odds ratio, 1.83 [95% CI, 1.05-3.18]). Conclusions- In patients with ESUS, nonstenotic carotid plaques were significantly more common on the side of the ischemic stroke, suggesting that these plaques could be a potential stroke etiology in patients in whom the ischemic stroke is classified currently as ESUS.
More Related Videos
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:28Imaging Studies for Cardiovascular System V: CT
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests