Atherosclerotic Plaque Ulceration in the Symptomatic Internal Carotid Artery Is Associated With Nonlacunar Ischemic Stroke

Abstract

Background and Purpose-Atherosclerotic carotid plaque ulceration is considered a marker of previous plaque rupture and subsequent thromboembolism. It can be accurately detected with multidetector CTA. We hypothesized that atherosclerotic plaque ulceration is associated with nonlacunar ischemic stroke rather than lacunar stroke. Methods-Prospectively, 750 consecutive patients with transient ischemic attack or ischemic stroke symptoms in the anterior cerebral circulation were evaluated for the presence of atherosclerotic plaque ulceration in the symptomatic carotid artery with multidetector CTA. Patients with stroke attributable to cardiac embolism or other specific etiologies and patients with amaurosis fugax were excluded. Ischemic strokes in the remaining 534 patients were classified as nonlacunar (nϭ236) or lacunar (nϭ298) based on clinical symptoms and multidetector CT of the brain. Ulceration was defined as extension of contrast material beyond the vascular lumen into the surrounding plaque. Results-Plaque ulceration in the symptomatic carotid artery was more common in nonlacunar strokes (nϭ47; 20%) as compared to lacunar strokes (nϭ20; 7%; PϽ0.001). After adjustment for age, gender, cardiovascular risk factors, and degree of stenosis, ulcerations were independently associated with nonlacunar stroke compared to lacunar stroke (odds ratio, 2.70; 95% confidence interval, 1.43-5.09). Conclusions-Atherosclerotic carotid plaque ulceration is associated with nonlacunar ischemic stroke, independent of the degree of carotid stenosis. These results suggest that nonlacunar stroke and lacunar stroke are caused by different pathophysiological mechanisms. (Stroke. 2010;41:1151-1156.)

Comparative Study of Risk Factors Between Lacunar and Non-lacunar Ischemic Strokes

“…However, the percentage of smoking, previous TIA and atrial fibrillation were not significantly (p>0.05) different between lacunar and non-lacunar stroke. 17 has observed higher mean age in their study patients which were 64±13 years and 61±13 years in Group A and in Group B respectively,the higher age range may be due to increased life expectancy in their study patients.…”

Is Aortic Atherothrombotic Disease Detected Using Multidetector-Row CT Associated With an Increased Risk of Early Ischemic Lesion Recurrence After Acute Ischemic Stroke?

“…3 Ulcerated plaque in the aortic arch was defined as extension of the contrast medium beyond the vascular lumen into the surrounding plaque with a wide orifice (Ͼ3 mm). 20,21 These were adopted from TEE criteria because MDCT-based criteria have not yet been established. 2,3 Using a cutoff of 180 Hounsfield units, plaques were classified as either calcified or noncalcified for analysis purposes.…”

Carotid Atherosclerotic Plaque Progression and Change in Plaque Composition Over Time: A 5-Year Follow-Up Study Using Serial CT Angiography

“…8 All patients with atherosclerotic plaque (ie, thickening and/or calcification of the vessel wall) in 1 or both carotid arteries were invited to participate in this serial imaging study. Exclusion criteria included no atherosclerotic plaque(s) present at the level of the carotid bifurcation, bilateral occlusion and/or treatment of the carotid arteries, no informed consent, renal insufficiency or hyperthyroidism, and bad image quality of the baseline scan.…”

“…Information was collected on age, sex, medication use, hypertension, hypercholesterolemia, diabetes mellitus, smoking, and history of cerebrovascular or cardiovascular disease, as previously described. 8 During the visit for the follow-up MDCTA scan, a detailed health questionnaire was taken.…”