plaque echolucency and emboli signals predict stroke in asymptomatic carotid stenosis

Vascular Laboratory and Imaging


Ultrasonic plaque echolucency and emboli signals predict stroke in asymptomatic carotid stenosis


Topakian R, For the ACES Investigators (St Georges Univ of London, UK; et al) Neurology 77:751–758, 2011§



G.L. Moneta, MD



Evidence Ranking


• C



Expert Rating


• 1



Abstract



Objectives


Better methods are required to identify patients with asymptomatic carotid stenosis (ACS) at risk of future stroke. Two potential markers of high risk are echolucent plaque morphology on carotid ultrasound and embolic signals (ES) in the ipsilateral middle cerebral artery on transcranial Doppler ultrasound (TCD). We explored the predictive value of a score based on these 2 measures in the prospective, observational, international multicenter Asymptomatic Carotid Emboli Study.



Methods


A total of 435 recruited subjects with ACS ≥70% had baseline ultrasound images and TCD data available. Subjects were prospectively followed up for 2 years.



Results


A total of 164 (37.7%) plaques were graded as echolucent. Plaque echolucency at baseline was associated with an increased risk of ipsilateral stroke alone (hazard ratio [HR] 6.43, 95% confidence interval [CI] 1.36–30.44, p = 0.019). A combined variable of plaque echolucency and ES positivity at baseline was associated with a markedly increased risk of ipsilateral stroke alone (HR 10.61, 95% CI 2.98–37.82, p = 0.0003). This association remained significant after controlling for risk factors, degree of carotid stenosis, and antiplatelet medication.



Conclusions


Plaque morphology assessed using a simple, and clinically applicable, visual rating scale predicts ipsilateral stroke risk in ACS. The combination of ES detection and plaque morphology allows a greater prediction than either measure alone and identifies a high-risk group with an annual stroke risk of 8%, and a low-risk group with a risk of <1% per annum. This risk stratification may prove useful in the selection of patients with ACS for endarterectomy (Fig).


image

Figure Kaplan-Meier plots showing the difference in endpoints between the groups with (green) and without (blue) both echolucent plaque and embolic signals. (A) Ipsilateral stroke and TIA, (B) ipsilateral stroke, (C) any stroke, and (D) any stroke and cardiovascular death. For interpretation of the references to color in this figure legend, the reader is referred to web version of this article. (Reprinted from Topakian R, For the ACES Investigators. Ultrasonic plaque echolucency and emboli signals predict stroke in asymptomatic carotid stenosis. Neurology. 2011;77:751–758.)

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Apr 1, 2017 | Posted by in CARDIOLOGY | Comments Off on plaque echolucency and emboli signals predict stroke in asymptomatic carotid stenosis

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