TY - JOUR
T1 - Complicated Carotid Artery Plaques and Risk of Recurrent Ischemic Stroke or TIA
AU - Kopczak, Anna
AU - Schindler, Andreas
AU - Sepp, Dominik
AU - Bayer-Karpinska, Anna
AU - Malik, Rainer
AU - Koch, Mia L.
AU - Zeller, Julia
AU - Strecker, Christoph
AU - Janowitz, Daniel
AU - Wollenweber, Frank A.
AU - Hempel, Johann Martin
AU - Boeckh-Behrens, Tobias
AU - Cyran, Clemens C.
AU - Helck, Andreas
AU - Harloff, Andreas
AU - Ziemann, Ulf
AU - Poli, Sven
AU - Poppert, Holger
AU - Saam, Tobias
AU - Dichgans, Martin
N1 - Publisher Copyright:
© 2022 The Authors
PY - 2022/6/7
Y1 - 2022/6/7
N2 - Background: Complicated nonstenosing carotid artery plaques (CAPs) are an under-recognized cause of stroke. Objectives: 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). Methods: 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. Results: 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. Conclusions: 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.
AB - Background: Complicated nonstenosing carotid artery plaques (CAPs) are an under-recognized cause of stroke. Objectives: 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). Methods: 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. Results: 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. Conclusions: 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.
KW - MRI
KW - carotid artery
KW - carotid plaque
KW - intraplaque hemorrhage
KW - ischemic stroke
KW - stroke recurrence
UR - http://www.scopus.com/inward/record.url?scp=85130251161&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2022.03.376
DO - 10.1016/j.jacc.2022.03.376
M3 - Article
C2 - 35523659
AN - SCOPUS:85130251161
SN - 0735-1097
VL - 79
SP - 2189
EP - 2199
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 22
ER -