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Symptomatic Non-stenotic Carotid Disease in Embolic Stroke of Undetermined Source : Analysis of the ESCAPE-NA1 Trial.
Marko, Martha; Singh, Nishita; Ospel, Johanna M; Uchida, Kazutaka; Almekhlafi, Mohammed A; Demchuk, Andrew M; Nogueira, Raul G; McTaggart, Ryan A; Poppe, Alexandre Y; Rempel, Jeremy L; Tymianski, Michael; Hill, Michael D; Goyal, Mayank; Menon, Bijoy K.
Afiliación
  • Marko M; Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. martha.marko@meduniwien.ac.at.
  • Singh N; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Ospel JM; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Uchida K; Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Almekhlafi MA; Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan.
  • Demchuk AM; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Nogueira RG; Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • McTaggart RA; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Poppe AY; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Rempel JL; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Tymianski M; Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Hill MD; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Goyal M; Emory University School of Medicine, Grady Memorial Hospital, Atlanta, USA.
  • Menon BK; Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
Clin Neuroradiol ; 34(2): 333-339, 2024 Jun.
Article en En | MEDLINE | ID: mdl-38108829
ABSTRACT

PURPOSE:

Non-stenotic (< 50%) carotid disease may play an important etiological role in ischemic stroke classified as embolic stroke of undetermined source (ESUS). We aimed to assess the prevalence of non-stenotic carotid disease and its association with ipsilateral ischemic stroke.

METHODS:

Data are from ESCAPE-NA1, a randomized controlled trial investigating the neuroprotectant nerinetide in patients with acute ischemic stroke and large vessel occlusion (LVO). The degree of stenosis of the extracranial internal carotid artery (ICA) and high-risk plaque features were assessed on baseline computed tomography (CT) angiography. We evaluated the association of non-stenotic carotid disease and ipsilateral stroke by age-adjusted and sex-adjusted logistic regression and calculated the attributable risk of ipsilateral stroke caused by non-stenotic carotid disease.

RESULTS:

After excluding patients with non-assessable imaging, symptomatic > 50% carotid stenosis and extracranial dissection, 799/1105 (72.1%) patients enrolled in ESCAPE-NA1 remained for this analysis. Of these, 127 (15.9%) were classified as ESUS. Non-stenotic carotid disease occurred in 34/127 ESUS patients (26.8%) and was associated with the presence of ipsilateral ischemic stroke (odds ratio, OR 1.6, 95% confidence interval, CI 1.0-2.6, p = 0.049). The risk of ipsilateral ischemic stroke attributable to non-stenotic carotid disease in ESUS was estimated to be 19.7% (95% CI -5.7% to 39%), the population attributable risk was calculated as 4.3%. Imaging features such as plaque thickness, plaque irregularity or plaque ulceration were not different between non-stenotic carotids with vs. without ipsilateral stroke.

CONCLUSION:

Non-stenotic carotid disease frequently occurs in patients classified as ESUS and is associated with ipsilateral ischemic stroke. Our findings support the role of non-stenotic carotid disease as stroke etiology in ESUS, but further prospective research is needed to prove a causal relationship.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Angiografía por Tomografía Computarizada Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Neuroradiol Asunto de la revista: NEUROLOGIA / RADIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Austria Pais de publicación: Alemania
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Angiografía por Tomografía Computarizada Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Neuroradiol Asunto de la revista: NEUROLOGIA / RADIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Austria Pais de publicación: Alemania