Protocols for Risk Prediction in Asymptomatic Carotid Stenosis Using Embolic Signal Detection: The Asymptomatic Carotid Emboli Study

Vascular Laboratory and Imaging


Optimizing Protocols for Risk Prediction in Asymptomatic Carotid Stenosis Using Embolic Signal Detection: The Asymptomatic Carotid Emboli Study


King A, for the ACES Investigators (St. Georges Univ of London, UK; et al) Stroke 42:2819–2824, 2011§



G.L. Moneta, MD



Evidence Ranking


• B



Expert Rating


• 1



Abstract



Background and Purpose


Improved methods are required to identify patients with asymptomatic carotid stenosis at high risk for stroke. The Asymptomatic Carotid Emboli Study recently showed embolic signals (ES) detected by transcranial Doppler on 2 recordings that lasted 1-hour independently predict 2-year stroke risk. ES detection is time-consuming, and whether similar predictive information could be obtained from simpler recording protocols is unknown.



Methods


In a predefined secondary analysis of Asymptomatic Carotid Emboli Study, we looked at the temporal variation of ES. We determined the predictive yield associated with different recording protocols and with the use of a higher threshold to indicate increased risk (≥2 ES). To compare the different recording protocols, sensitivity and specificity analyses were performed using analysis of receiver-operator characteristic curves.



Results


Of 477 patients, 467 had baseline recordings adequate for analysis; 77 of these had ES on 1 or both of the 2 recordings. ES status on the 2 recordings was significantly associated (P<0.0001), but there was poor agreement between ES positivity on the 2 recordings (κ=0.266). For the primary outcome of ipsilateral stroke or transient ischemic attack, the use of 2 baseline recordings lasting 1 hour had greater predictive accuracy than either the first baseline recording alone (P=0.0005), a single 30-minute (P<0.0001) recording, or 2 recordings lasting 30 minutes (P<0.0001). For the outcome of ipsilateral stroke alone, two recordings lasting 1 hour had greater predictive accuracy when compared to all other recording protocols (all P<0.0001).

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Apr 1, 2017 | Posted by in CARDIOLOGY | Comments Off on Protocols for Risk Prediction in Asymptomatic Carotid Stenosis Using Embolic Signal Detection: The Asymptomatic Carotid Emboli Study

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