scholarly journals A Risk Score Including Carotid Plaque Inflammation and Stenosis Severity Improves Identification of Recurrent Stroke

Stroke ◽  
2020 ◽  
Vol 51 (3) ◽  
pp. 838-845 ◽  
Author(s):  
Peter J. Kelly ◽  
Pol Camps-Renom ◽  
Nicola Giannotti ◽  
Joan Martí-Fàbregas ◽  
Jonathan P. McNulty ◽  
...  
Keyword(s):  
Risk Score ◽  
Carotid Plaque ◽  
Recurrent Stroke ◽  
Stenosis Severity ◽  
Plaque Inflammation

Carotid Plaque Inflammation Imaged by PET and Prediction of Recurrent Stroke at 5 Years

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012909
Author(s):  
John Joseph McCabe ◽  
Pol Camps-Renom ◽  
Nicola Giannotti ◽  
Jonathan P. McNulty ◽  
Sarah Coveney ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Pet Imaging ◽  
Carotid Plaque ◽  
Recurrent Stroke ◽  
Carotid Revascularization ◽  
Fdg Uptake ◽  
Pet Ct ◽  
Stenosis Severity ◽  
Plaque Inflammation

Objective:To determine whether carotid plaque inflammation identified by 18F-fluorodeoxyglucose (18FDG)-PET is associated with late (5-year) recurrent stroke.Methods:We did an individual-participant data pooled analysis of three prospective studies with near-identical study methods. Eligible patients had recent non-severe (modified Rankin Score ≤3) ischaemic stroke/TIA and ipsilateral carotid stenosis (50-99%). Participants underwent carotid 18FDG-PET/CT angiography ≤14 days after recruitment. 18FDG uptake was expressed as maximum standardized uptake value (SUVmax) in the axial single hottest slice of symptomatic plaque. We calculated the previously-validated Symptomatic Carotid Atheroma Inflammation Lumen-stenosis (SCAIL) score, which incorporates a measure of stenosis severity and 18FDG uptake. The primary outcome was 5-year recurrent ipsilateral ischaemic stroke after PET imaging.Results:Of 183 eligible patients, 181 patients completed follow-up (98.9%). The median duration of follow-up was 4.9 years (interquartile range 3.3-6.4, cumulative follow-up period 901.8 patient-years). After PET imaging, 17 patients had a recurrent ipsilateral ischemic strokes at 5 years (recurrence rate 9.4%, 95% CI 5.6-14.6%). Baseline plaque SUVmax independently predicted 5-year ipsilateral recurrent stroke after adjustment for age, gender, carotid revascularization, stenosis severity, NIH Stroke Scale, and diabetes mellitus (adjusted HR 1.98; 95 % CI, 1.10-3.56, p=0.02, per 1g/mL increase SUVmax). On multivariable Cox regression, SCAIL score predicted 5-year ipsilateral stroke (adjusted HR 2.73 per 1-point increase; 95% CI 1.52-4.90, p=0.001).Conclusion:Plaque inflammation-related 18FDG uptake improved identification of 5-year recurrent ipsilateral ischaemic stroke. Addition of plaque inflammation to current selection strategies may target patients most likely to have late as well as early benefit from carotid revascularization.Classification of Evidence:This study provides Class I evidence that in individuals with recent ischemic stroke/TIA and ipsilateral carotid stenosis, carotid plaque inflammation-related 18FDG uptake on PET/CT angiography was associated with 5-year recurrent ipsilateral stroke.

scholarly journals Cohort profile: BIOVASC-late, a prospective multicentred study of imaging and blood biomarkers of carotid plaque inflammation and risk of late vascular recurrence after non-severe stroke in Ireland

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038607
Author(s):  
John Joseph McCabe ◽  
Nicola Giannotti ◽  
Jonathan McNulty ◽  
Sean Collins ◽  
Sarah Coveney ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Inflammatory Cytokines ◽  
Fdg Pet ◽  
Carotid Plaque ◽  
Recurrent Stroke ◽  
Vascular Events ◽  
Severe Stroke ◽  
Symptomatic Carotid ◽  
Fdg Uptake ◽  
Plaque Inflammation

PurposeInflammation is important in stroke. Anti-inflammatory therapy reduces vascular events in coronary patients. 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) identifies plaque inflammation-related metabolism. However, long-term prospective cohort studies investigating the association between carotid plaque inflammation, identified on 18F-FDG PET and the risk of recurrent vascular events, have not yet been undertaken in patients with stroke.ParticipantsThe Biomarkers Imaging Vulnerable Atherosclerosis in Symptomatic Carotid disease (BIOVASC) study and Dublin Carotid Atherosclerosis Study (DUCASS) are two prospective multicentred observational cohort studies, employing near-identical methodologies, which recruited 285 patients between 2008 and 2016 with non-severe stroke/transient ischaemic attack and ipsilateral carotid stenosis (50%–99%). Patients underwent coregistered carotid 18F-FDG PET/CT angiography and phlebotomy for measurement of inflammatory cytokines. Plaque 18F-FDG-uptake is expressed as maximum standardised uptake value (SUVmax) and tissue-to-background ratio. The BIOVASC-Late study is a follow-up study (median 7 years) of patients recruited to the DUCASS/BIOVASC cohorts.Findings to dateWe have reported that 18F-FDG-uptake in atherosclerotic plaques of patients with symptomatic carotid stenosis predicts early recurrent stroke, independent of luminal narrowing. The incorporation of 18F-FDG plaque uptake into a clinical prediction model also improves discrimination of early recurrent stroke, when compared with risk stratification by luminal stenosis alone. However, the relationship between 18F-FDG-uptake and late vascular events has not been investigated to date.Future plansThe primary aim of BIOVASC-Late is to investigate the association between SUVmax in symptomatic ‘culprit’ carotid plaque (as a marker of systemic inflammatory atherosclerosis) and the composite outcome of any late major vascular event (recurrent ischaemic stroke, coronary event or vascular death). Secondary aims are to investigate associations between: (1) SUVmax in symptomatic plaque, and individual vascular endpoints (2) SUVmax in asymptomatic contralateral carotid plaque and SUVmax in ipsilateral symptomatic plaque (3) SUVmax in asymptomatic carotid plaque and major vascular events (4) inflammatory cytokines and vascular events.

When to image carotid plaque inflammation with FDG PET/CT

2010 ◽  
Vol 31 (9) ◽  
pp. 773-779 ◽  
Author(s):  
Martin Graebe ◽  
Lise Borgwardt ◽  
Liselotte Højgaard ◽  
Henrik Sillesen ◽  
Andreas Kjaer
Keyword(s):  
Fdg Pet ◽  
Carotid Plaque ◽  
Pet Ct ◽  
Plaque Inflammation ◽  
Fdg Pet Ct

Risks of Stroke Recurrence and Mortality After First and Recurrent Strokes in Denmark: A Nationwide Registry Study

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013118
Author(s):  
Nils Skajaa ◽  
Kasper Adelborg ◽  
Erzsébet Horváth-Puhó ◽  
Kenneth J Rothman ◽  
Victor W. Henderson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Risk Score ◽  
Recurrent Stroke ◽  
Recurrent Event ◽  
Risk Scores ◽  
Stroke Recurrence ◽  
Stroke Severity ◽  
Risk Of Death ◽  
First Time

Background and Objectives:To examine risks of stroke recurrence and mortality after first and recurrent stroke.Methods:Using Danish nationwide health registries, we included patients (age ≥18 years) with first-time ischemic stroke (N = 105,397) or intracerebral hemorrhage (N = 13,350) during 2004–2018. Accounting for the competing risk of death, absolute risks of stroke recurrence were computed separately for each stroke subtype and within strata of age groups, sex, stroke severity, body mass index, smoking, alcohol, the Essen stroke risk score, and atrial fibrillation. Mortality risks were computed after first and recurrent stroke.Results:After adjusting for competing risks, the overall 1-year and 10-year risks of recurrence were 4% and 13% following first-time ischemic stroke and 3% and 12% following first-time intracerebral hemorrhage. For ischemic stroke, the risk of recurrence increased with age, was higher for men and following mild than more severe stroke. The most marked differences were across Essen risk scores, for which recurrence risks increased with increasing scores. For intracerebral hemorrhage, risks were similar for both sexes and did not increase with Essen risk score. For ischemic stroke, the 1-year and 10-year risks of all-cause mortality were 17% and 56% after a first-time stroke and 25% and 70% after a recurrent stroke; corresponding estimates for intracerebral hemorrhage were 37% and 70% after a first-time event and 31% and 75% after a recurrent event.Conclusion:The risk of stroke recurrence was substantial following both subtypes, but risks differed markedly among patient subgroups. The risk of mortality was higher after a recurrent than first-time stroke.

scholarly journals Risk of recurrent stroke and antiplatelet choice in breakthrough stroke while on aspirin

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Joon-Tae Kim ◽  
Beom Joon Kim ◽  
Jong-Moo Park ◽  
Soo Joo Lee ◽  
Jae-Kwan Cha ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Risk Score ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Vascular Events ◽  
Factors Associated ◽  
Increased Risk ◽  
Potential Factors ◽  
Predictive Risk ◽  
Multicenter Registry

Abstract Uncertainty regarding an optimal antiplatelet regimen still exists in patients with breakthrough acute ischemic stroke (AIS) while on aspirin. This study provides an analysis of a prospective multicenter registry between April 2008 and April 2014. Eligible patients were on aspirin at the time of AIS and treated with antiplatelet regimens (aspirin, clopidogrel, or clopidogrel-aspirin). Potential factors associated with the choice of each antiplatelet regimen were explored and included a predictive risk score for future vascular events, the Essen Stroke Risk Score (ESRS). A total of 2348 patients (age, 69 ± 11 years; male, 57.7%) were analyzed, and 55.3%, 25.3% and 19.4% were treated with clopidogrel-aspirin, aspirin and clopidogrel, respectively. While the likelihood of choosing clopidogrel-aspirin increased as the ESRS increased, the likelihood of choosing aspirin decreased as the ESRS increased (Ptrend < 0.001). The ESRS category (0–1/2–3/ ≥ 4) modified the effect of antiplatelet regimens for 1-year vascular events (Pinteraction < 0.01). Among patients with ESRS ≥ 4, clopidogrel-aspirin (HR 0.47 [0.30–0.74]) and clopidogrel (HR 0.30 [0.15–0.60]) significantly reduced the risk of outcome events. Our study showed that more than half of the patients with aspirin failure were treated with clopidogrel-aspirin. In particular, a higher ESRS, which indicates an increased risk of recurrent stroke, was associated with the choice of clopidogrel-aspirin rather than aspirin.

HIGH OSTEOPONTIN (OPN) N-TERMINAL/C-TERMINAL RATIO IS ASSOCIATED WITH CAROTID PLAQUE INFLAMMATION

2011 ◽  
Vol 29 ◽  
pp. e20
Author(s):  
T. Wolak ◽  
n. Sion-Vardy ◽  
G. Greenberg ◽  
G. Szendro ◽  
A. Rudich ◽  
...  
Keyword(s):  
Carotid Plaque ◽  
Plaque Inflammation

P3716Increased two-year cerebrovascular event rate in patients with bilateral high carotid tempratures

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Benetos ◽  
K Toutouzas ◽  
G Oikonomou ◽  
I Koutagiar ◽  
M Karmpalioti ◽  
...  
Keyword(s):  
Carotid Plaque ◽  
Cerebrovascular Event ◽  
Stroke Rate ◽  
Kaplan Meier ◽  
Cerebrovascular Events ◽  
Rigorous Research ◽  
Plaque Inflammation ◽  
Artery Disease ◽  
Documented Coronary Artery Disease

Abstract Introduction The association of carotid plaque inflammation with cerebrovascular events is a matter of rigorous research. Microwave Radiometry (MWR) allows in vivo noninvasive measurement of the internal temperatures of tissues, reflecting inflammation. Purpose To investigate whether increased carotid temperatures in patients with documented coronary artery disease (CAD) are associated with cerebrovascular events. Methods Consecutive patients with significant CAD from three tertiary centers were included in the study. Maximum carotid plaque thickness was assessed in all carotids by ultrasound. ΔT by MWR was assigned as the temperature difference (maximal minus minimum) along the carotid artery. ΔT ≥0.90°C was assigned as high ΔT. All patients were followed-up clinically for two years and all strokes were adjudicated by an independent committee. Transient ischemic attacks were excluded. Results In total 300 patients were included in the study. High ΔT temperatures bilaterally were measured in 47 patients (15.7%). Three patients (1.0%) suffered a stroke, including one fatal. Stoke rate was 4.3% in the group with bilateral high ΔT and 0.4% in non-high ΔT group (p=0.02). In Kaplan-Meier plot patients with bilateral high ΔT showed higher stroke rate (log-rank p=0.004, figure) Conclusions Bilateral high carotid temperatures are associated with increased two-year stroke rate. The potential value of the present finding in risk stratification of intermediate carotid stenosis mandates further investigation.

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