Complicated Carotid Artery Plaques and Risk of Recurrent Ischemic Stroke or TIA
Complicated nonstenosing carotid artery plaques (CAPs) are an under-recognized cause of stroke. The purpose of this study was to determine whether complicated CAP ipsilateral to acute ischemic anterior circulation stroke (icCAP) are associated with recurrent ischemic stroke or transient ischemic att...
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| Vydáno v: | Journal of the American College of Cardiology Ročník 79; číslo 22; s. 2189 |
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07.06.2022
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| Abstract | Complicated nonstenosing carotid artery plaques (CAPs) are an under-recognized cause of stroke.
The purpose of this study was to determine whether complicated CAP ipsilateral to acute ischemic anterior circulation stroke (icCAP) are associated with recurrent ischemic stroke or transient ischemic attack (TIA).
The CAPIAS (Carotid Plaque Imaging in Acute Stroke) multicenter study prospectively recruited patients with ischemic stroke restricted to the territory of a single carotid artery. Complicated (AHA-lesion type VI) CAP were defined by multisequence, contrast-enhanced carotid magnetic resonance imaging obtained within 10 days from stroke onset. Recurrent events were assessed after 3, 12, 24, and 36 months. The primary outcome was recurrent ischemic stroke or TIA.
Among 196 patients enrolled, 104 patients had cryptogenic stroke and nonstenosing CAP. During a mean follow-up of 30 months, recurrent ischemic stroke or TIA occurred in 21 patients. Recurrent events were significantly more frequent in patients with icCAP than in patients without icCAP, both in the overall cohort (incidence rate [3-year interval]: 9.50 vs 3.61 per 100 patient-years; P = 0.025, log-rank test) and in patients with cryptogenic stroke (10.92 vs 1.82 per 100 patient-years; P = 0.003). The results were driven by ipsilateral events. A ruptured fibrous cap (HR: 4.91; 95% CI: 1.31-18.45; P = 0.018) and intraplaque hemorrhage (HR: 4.37; 95% CI: 1.20-15.97; P = 0.026) were associated with a significantly increased risk of recurrent events in patients with cryptogenic stroke.
Complicated CAP ipsilateral to acute ischemic anterior circulation stroke are associated with an increased risk of recurrent ischemic stroke or TIA. Carotid plaque imaging identifies high-risk patients who might be suited for inclusion into future secondary prevention trials. (Carotid Plaque Imaging in Acute Stroke [CAPIAS]; NCT01284933). |
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| AbstractList | Complicated nonstenosing carotid artery plaques (CAPs) are an under-recognized cause of stroke.
The purpose of this study was to determine whether complicated CAP ipsilateral to acute ischemic anterior circulation stroke (icCAP) are associated with recurrent ischemic stroke or transient ischemic attack (TIA).
The CAPIAS (Carotid Plaque Imaging in Acute Stroke) multicenter study prospectively recruited patients with ischemic stroke restricted to the territory of a single carotid artery. Complicated (AHA-lesion type VI) CAP were defined by multisequence, contrast-enhanced carotid magnetic resonance imaging obtained within 10 days from stroke onset. Recurrent events were assessed after 3, 12, 24, and 36 months. The primary outcome was recurrent ischemic stroke or TIA.
Among 196 patients enrolled, 104 patients had cryptogenic stroke and nonstenosing CAP. During a mean follow-up of 30 months, recurrent ischemic stroke or TIA occurred in 21 patients. Recurrent events were significantly more frequent in patients with icCAP than in patients without icCAP, both in the overall cohort (incidence rate [3-year interval]: 9.50 vs 3.61 per 100 patient-years; P = 0.025, log-rank test) and in patients with cryptogenic stroke (10.92 vs 1.82 per 100 patient-years; P = 0.003). The results were driven by ipsilateral events. A ruptured fibrous cap (HR: 4.91; 95% CI: 1.31-18.45; P = 0.018) and intraplaque hemorrhage (HR: 4.37; 95% CI: 1.20-15.97; P = 0.026) were associated with a significantly increased risk of recurrent events in patients with cryptogenic stroke.
Complicated CAP ipsilateral to acute ischemic anterior circulation stroke are associated with an increased risk of recurrent ischemic stroke or TIA. Carotid plaque imaging identifies high-risk patients who might be suited for inclusion into future secondary prevention trials. (Carotid Plaque Imaging in Acute Stroke [CAPIAS]; NCT01284933). Complicated nonstenosing carotid artery plaques (CAPs) are an under-recognized cause of stroke.BACKGROUNDComplicated nonstenosing carotid artery plaques (CAPs) are an under-recognized cause of stroke.The purpose of this study was to determine whether complicated CAP ipsilateral to acute ischemic anterior circulation stroke (icCAP) are associated with recurrent ischemic stroke or transient ischemic attack (TIA).OBJECTIVESThe purpose of this study was to determine whether complicated CAP ipsilateral to acute ischemic anterior circulation stroke (icCAP) are associated with recurrent ischemic stroke or transient ischemic attack (TIA).The CAPIAS (Carotid Plaque Imaging in Acute Stroke) multicenter study prospectively recruited patients with ischemic stroke restricted to the territory of a single carotid artery. Complicated (AHA-lesion type VI) CAP were defined by multisequence, contrast-enhanced carotid magnetic resonance imaging obtained within 10 days from stroke onset. Recurrent events were assessed after 3, 12, 24, and 36 months. The primary outcome was recurrent ischemic stroke or TIA.METHODSThe CAPIAS (Carotid Plaque Imaging in Acute Stroke) multicenter study prospectively recruited patients with ischemic stroke restricted to the territory of a single carotid artery. Complicated (AHA-lesion type VI) CAP were defined by multisequence, contrast-enhanced carotid magnetic resonance imaging obtained within 10 days from stroke onset. Recurrent events were assessed after 3, 12, 24, and 36 months. The primary outcome was recurrent ischemic stroke or TIA.Among 196 patients enrolled, 104 patients had cryptogenic stroke and nonstenosing CAP. During a mean follow-up of 30 months, recurrent ischemic stroke or TIA occurred in 21 patients. Recurrent events were significantly more frequent in patients with icCAP than in patients without icCAP, both in the overall cohort (incidence rate [3-year interval]: 9.50 vs 3.61 per 100 patient-years; P = 0.025, log-rank test) and in patients with cryptogenic stroke (10.92 vs 1.82 per 100 patient-years; P = 0.003). The results were driven by ipsilateral events. A ruptured fibrous cap (HR: 4.91; 95% CI: 1.31-18.45; P = 0.018) and intraplaque hemorrhage (HR: 4.37; 95% CI: 1.20-15.97; P = 0.026) were associated with a significantly increased risk of recurrent events in patients with cryptogenic stroke.RESULTSAmong 196 patients enrolled, 104 patients had cryptogenic stroke and nonstenosing CAP. During a mean follow-up of 30 months, recurrent ischemic stroke or TIA occurred in 21 patients. Recurrent events were significantly more frequent in patients with icCAP than in patients without icCAP, both in the overall cohort (incidence rate [3-year interval]: 9.50 vs 3.61 per 100 patient-years; P = 0.025, log-rank test) and in patients with cryptogenic stroke (10.92 vs 1.82 per 100 patient-years; P = 0.003). The results were driven by ipsilateral events. A ruptured fibrous cap (HR: 4.91; 95% CI: 1.31-18.45; P = 0.018) and intraplaque hemorrhage (HR: 4.37; 95% CI: 1.20-15.97; P = 0.026) were associated with a significantly increased risk of recurrent events in patients with cryptogenic stroke.Complicated CAP ipsilateral to acute ischemic anterior circulation stroke are associated with an increased risk of recurrent ischemic stroke or TIA. Carotid plaque imaging identifies high-risk patients who might be suited for inclusion into future secondary prevention trials. (Carotid Plaque Imaging in Acute Stroke [CAPIAS]; NCT01284933).CONCLUSIONSComplicated CAP ipsilateral to acute ischemic anterior circulation stroke are associated with an increased risk of recurrent ischemic stroke or TIA. Carotid plaque imaging identifies high-risk patients who might be suited for inclusion into future secondary prevention trials. (Carotid Plaque Imaging in Acute Stroke [CAPIAS]; NCT01284933). |
| Author | Cyran, Clemens C Helck, Andreas Harloff, Andreas Wollenweber, Frank A Sepp, Dominik Strecker, Christoph Dichgans, Martin Bayer-Karpinska, Anna Poli, Sven Malik, Rainer Koch, Mia L Saam, Tobias Schindler, Andreas Boeckh-Behrens, Tobias Poppert, Holger Zeller, Julia Janowitz, Daniel Kopczak, Anna Hempel, Johann-Martin Ziemann, Ulf |
| Author_xml | – sequence: 1 givenname: Anna surname: Kopczak fullname: Kopczak, Anna organization: Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany – sequence: 2 givenname: Andreas surname: Schindler fullname: Schindler, Andreas organization: Department of Radiology, University Hospital, LMU Munich, Munich, Germany; Department of Neuroradiology, University Hospital, LMU Munich, Munich, Germany – sequence: 3 givenname: Dominik surname: Sepp fullname: Sepp, Dominik organization: Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany – sequence: 4 givenname: Anna surname: Bayer-Karpinska fullname: Bayer-Karpinska, Anna organization: Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Klinikum Fürstenfeldbruck, Neurology, Fürstenfeldbruck, Germany – sequence: 5 givenname: Rainer surname: Malik fullname: Malik, Rainer organization: Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany – sequence: 6 givenname: Mia L surname: Koch fullname: Koch, Mia L organization: Department of Neurology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany – sequence: 7 givenname: Julia surname: Zeller fullname: Zeller, Julia organization: Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany – sequence: 8 givenname: Christoph surname: Strecker fullname: Strecker, Christoph organization: Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany – sequence: 9 givenname: Daniel surname: Janowitz fullname: Janowitz, Daniel organization: Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany – sequence: 10 givenname: Frank A surname: Wollenweber fullname: Wollenweber, Frank A organization: Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Department of Neurology, Helios Dr Horst-Schmidt-Kliniken, Wiesbaden, Germany – sequence: 11 givenname: Johann-Martin surname: Hempel fullname: Hempel, Johann-Martin organization: Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany – sequence: 12 givenname: Tobias surname: Boeckh-Behrens fullname: Boeckh-Behrens, Tobias organization: Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany – sequence: 13 givenname: Clemens C surname: Cyran fullname: Cyran, Clemens C organization: Department of Radiology, University Hospital, LMU Munich, Munich, Germany – sequence: 14 givenname: Andreas surname: Helck fullname: Helck, Andreas organization: Radiology and Neuroradiology Zurich, Hirslanden/Klinik im Park, Zurich, Switzerland – sequence: 15 givenname: Andreas surname: Harloff fullname: Harloff, Andreas organization: Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany – sequence: 16 givenname: Ulf surname: Ziemann fullname: Ziemann, Ulf organization: Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany – sequence: 17 givenname: Sven surname: Poli fullname: Poli, Sven organization: Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany – sequence: 18 givenname: Holger surname: Poppert fullname: Poppert, Holger organization: Department of Neurology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany; Department of Neurology, Helios Klinikum München West, Munich, Germany – sequence: 19 givenname: Tobias surname: Saam fullname: Saam, Tobias organization: Department of Radiology, University Hospital, LMU Munich, Munich, Germany; Radiologisches Zentrum Rosenheim, Rosenheim, Germany – sequence: 20 givenname: Martin surname: Dichgans fullname: Dichgans, Martin email: martin.dichgans@med.uni-muenchen.de organization: Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany. Electronic address: martin.dichgans@med.uni-muenchen.de |
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| Keywords | carotid plaque MRI carotid artery intraplaque hemorrhage ischemic stroke stroke recurrence |
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| Snippet | Complicated nonstenosing carotid artery plaques (CAPs) are an under-recognized cause of stroke.
The purpose of this study was to determine whether complicated... Complicated nonstenosing carotid artery plaques (CAPs) are an under-recognized cause of stroke.BACKGROUNDComplicated nonstenosing carotid artery plaques (CAPs)... |
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| SubjectTerms | Carotid Arteries - pathology Carotid Stenosis - complications Carotid Stenosis - diagnostic imaging Carotid Stenosis - epidemiology Humans Ischemic Attack, Transient - epidemiology Ischemic Attack, Transient - etiology Ischemic Stroke Plaque, Atherosclerotic - complications Plaque, Atherosclerotic - diagnostic imaging Plaque, Atherosclerotic - pathology Risk Factors Stroke - diagnosis Stroke - epidemiology Stroke - etiology |
| Title | Complicated Carotid Artery Plaques and Risk of Recurrent Ischemic Stroke or TIA |
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