Clinical and Carotid Plaque Features in Symptomatic and Asymptomatic Ischemic Stroke
Shili Zhou1,2, Yanhong Yan1, Pinjing Hui1
1Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Insights
Plaque vulnerability, coronary heart disease, and hypoechoic plaque are key predictors of symptomatic ischemic stroke. These factors aid in identifying high-risk patients for better clinical management.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Medical Imaging
Background:
- Ischemic stroke (IS) is a major cerebrovascular condition often linked to carotid intima-media (CIA) stenosis.
- Symptomatic CIA stenosis poses a significant risk of recurrent ischemic events within 12 weeks.
- Asymptomatic CIA stenosis carries a lower but persistent annual risk of stroke.
Purpose of the Study:
- To evaluate the diagnostic value of clinical features and carotid plaque characteristics in predicting symptomatic versus asymptomatic ischemic stroke.
- To identify independent predictors of symptomatic ischemic stroke.
- To develop and assess a clinical-ultrasonographic prediction model for IS.
Main Methods:
- A cohort of 543 patients with confirmed internal carotid artery stenosis underwent assessment.
- Patients were classified into symptomatic (n=356) and asymptomatic (n=187) groups based on clinical presentation and brain imaging (CT/MRI).
- Logistic regression analysis was employed to identify risk factors, analyzing demographic data, clinical features, and carotid plaque ultrasonography characteristics.
Main Results:
- Key differentiating factors included coronary heart disease (CHD), degree of stenosis, plaque diameter, plaque length, plaque vulnerability, and plaque echo type.
- Multivariate analysis identified plaque vulnerability, CHD, and plaque hypoechogenicity as independent predictors of symptomatic stroke.
- The developed clinical-ultrasonographic model demonstrated strong predictive performance with an AUC of 0.85, sensitivity of 0.74, and specificity of 0.81.
Conclusions:
- Plaque vulnerability, presence of CHD, and plaque hypoechogenicity are significant predictors of symptomatic ischemic stroke.
- These identified factors warrant close attention for risk stratification and future management strategies in patients with carotid artery stenosis.
- The predictive model offers a valuable tool for assessing stroke risk in clinical practice.
Abstract:
Aims/Background Ischemic stroke (IS), a cerebrovascular condition, is commonly detected by evaluating carotid intima-media (CIA) stenosis. Symptomatic CIA stenosis carries a high risk (up to 32%) of another ischemic event within 12 weeks, while asymptomatic CIA stenosis has an annual risk ranging from 1% to 2%. Therefore, this study aims to explore the diagnostic value of clinical features and carotid plaque characteristics in both symptomatic and asymptomatic IS. Methods This study enrolled 543 consecutive patients with internal carotid artery stenosis confirmed by carotid ultrasonography. Participants were categorized into the symptomatic group (n = 356) and the asymptomatic group (n = 187) by clinical symptoms and computed tomography (CT)/magnetic resonance imaging (MRI) of the brain. Demographic data, clinical features, and ultrasonographic characteristics of the carotid plaque were collected, and logistics regression analysis was carried out to explore the predictive risk factors of IS. Results According to the differences in clinical and carotid plaque characteristics between the two groups, coronary heart disease (CHD), stenosis degree, plaque diameter, plaque length, plaque vulnerability, and plaque echo type were included. The results of the multivariate logistics regression analysis showed that plaque vulnerability, CHD, and plaque hypoechogenicity were independent predictors of symptomatic stroke. The clinical-ultrasonographic prediction model showed an area under the curve (AUC) of 0.85 [95% confidence interval (CI): 0.82-0.88], a sensitivity of 0.74 (95% CI: 0.69-0.78), and a specificity of 0.81 (95% CI: 0.76-0.87), with a good performance in the model prediction. Conclusion Plaque vulnerability, CHD, and plaque hypoechogenicity are meaningful predictors of symptomatic ischemic stroke and deserve attention in the future.
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