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Use of optical coherence tomography in selected patients with recurrent cryptogenic stroke: A case series and
Răzvan Alexandru Radu1, Federico Cagnazzo1, Imad Derraz1
1Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
Insights
Intravascular optical coherence tomography (OCT) safely identified hidden carotid artery issues, like carotid web disease and plaques, in patients with recurrent cryptogenic stroke. This imaging helps guide effective carotid stenting to lower stroke recurrence risk.
Area of Science:
- Neuroscience
- Cardiovascular Medicine
- Medical Imaging
Background:
- Cryptogenic stroke carries a high recurrence risk despite advances in secondary prevention.
- Large artery disease, particularly complex carotid plaques and carotid webs, is linked to increased stroke recurrence.
- Conventional imaging often fails to identify the etiology of recurrent cryptogenic strokes.
Purpose of the Study:
- To evaluate the utility of intravascular optical coherence tomography (OCT) in identifying covert carotid lesions in patients with cryptogenic recurrent stroke.
- To assess the safety and feasibility of OCT for diagnosing carotid artery abnormalities.
- To determine if OCT findings can guide treatment decisions for stroke prevention.
Main Methods:
- A case series of six patients with cryptogenic recurrent stroke was conducted.
- Intravascular OCT, utilizing a balloon-guided flow-arrest technique, was performed to visualize the carotid artery wall.
- Conventional imaging and extensive workup were insufficient to determine stroke etiology prior to OCT.
Main Results:
- OCT identified carotid web disease with thrombosis in three patients and ulcerated carotid artery plaques in two patients.
- OCT successfully distinguished between complicated carotid artery plaques and carotid web disease.
- Four patients underwent successful endovascular stent placement following OCT diagnosis, without complications.
Conclusions:
- Intravascular OCT is a safe and feasible method for detecting covert carotid wall abnormalities, including carotid web disease and ulcerated plaques.
- Identifying these lesions with OCT allows for targeted carotid stenting, potentially reducing the risk of recurrent stroke.
- OCT imaging provides crucial diagnostic information for managing patients at high risk for cryptogenic stroke recurrence.
Background:
Despite advances in secondary stroke prevention during the last several years, cryptogenic stroke remains associated with a high risk of recurrence. Studies have shown that the recurrence risk is higher in patients with large artery disease in which complex carotid plaques and carotid WEBs are identified.
Methods:
This is a case series of six patients with cryptogenic recurrent stroke in which conventional imaging and extensive workup did not identify an etiology. Intravascular optic coherence tomography (OCT) was performed using a ballon-guided flow-arrest technique to identify possible covert carotid lesions.
Results:
We present six cases in which, with the help of OCT, we identified three carotid WEBs with associated thrombosis and two ulcerated carotid artery plaques. Four patients were subsequently treated with endovascular stent placement without complications. OCT permitted the distinction between complicated carotid artery plaque and carotid WEB.
Conclusion:
Intravascular OCT is a feasible and safe approach to identifying patients with covert carotid wall abnormalities, like carotid WEBs and ulcerated plaques, that are amenable to carotid stenting to reduce recurrent stroke risk.
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