Carotid Plaque Characteristics Predict Recurrent Ischemic Stroke and TIA

Dam-Nolen, Dianne H.K. van; Truijman, Martine T. B.; Kolk, Anja G. van der; Liem, Madieke I.; Schreuder, Floris H.B.M.; Boersma, Eric; Daemen, M. J. A. P.; Mess, Werner H.; Oostenbrugge, Robert J. van; Steen, Antonius F.W. van der; Bos, Daniel; Koudstaal, Peter J.; Nederkoorn, Paul J.; Hendrikse, Jeroen; Lugt, Aad van der; Kooi, Marianne Eline

doi:10.1016/j.jcmg.2022.04.003

Cited by 40 publications

(20 citation statements)

References 41 publications

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“…The most commonly chosen stenosis threshold to define SyNC was <50%, and one study used an additional lower threshold of 30%, with SyNC being defined as 30–49% carotid stenosis. Two studies chose <70% stenosis for their SyNC definition 10 11. Additional criteria that were used included the presence of intraplaque hemorrhage8 or plaque thickness >3 mm 12.…”

Section: Sync Definitionmentioning

confidence: 99%

“…Since many studies did not use a clear SyNC definition, one can only provide rough estimates on future stroke risk. Probably the most thorough, comprehensive study that was conducted on this question is the prospective, longitudinal multicenter Plaque-At-Risk (PARISK) cohort study that included patients with recent transient ischemic attack (TIA) or minor stroke and ipsilateral carotid plaques causing <70% stenosis 11. During 5.1 years follow-up, 37/238 (16%) patients suffered a recurrent stroke or TIA, with MRI evidence of new infarcts in 19/238 (8%) patients 11.…”

Section: Risk Of Stroke In Sync Patientsmentioning

confidence: 99%

“…Probably the most thorough, comprehensive study that was conducted on this question is the prospective, longitudinal multicenter Plaque-At-Risk (PARISK) cohort study that included patients with recent transient ischemic attack (TIA) or minor stroke and ipsilateral carotid plaques causing <70% stenosis 11. During 5.1 years follow-up, 37/238 (16%) patients suffered a recurrent stroke or TIA, with MRI evidence of new infarcts in 19/238 (8%) patients 11. Intraplaque hemorrhage and total plaque volume (both assessed on MRI) were associated with recurrent ipsilateral stroke or TIA, with hazard ratios of 2.12 (95% CI 1.02 to 4.44) and 1.07 (95% CI 1.00 to 1.15) per 100 µL increase, respectively.…”

Section: Risk Of Stroke In Sync Patientsmentioning

confidence: 99%

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Symptomatic non-stenotic carotid disease: current challenges and opportunities for diagnosis and treatment

Ospel

Kappelhof

Ganesh

et al. 2023

J NeuroIntervent Surg

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Symptomatic non-stenotic carotid plaques (SyNC) are an under-researched and under-recognized source of stroke. Various imaging markers of non-stenotic carotid plaques that are associated with stroke risk have been identified, but these causal relationships need to be confirmed in additional prospective studies. Currently, there exists neither a standardized SyNC definition nor a dedicated set of imaging protocols, although researchers have started to address these shortcomings. Moreover, many neuroradiologists are still unaware of the condition, and hence do not comment on high-risk plaque features other than stenosis in their reports. Regarding SyNC treatment, scant data exist as to whether and to what extent medical, interventional and surgical treatments could influence the course of the disease; the relative lack of data on the ‘natural’ history of untreated SyNC makes treatment comparisons difficult. In our opinion, endovascular SyNC treatment represents the most promising treatment option for SyNC, since it allows for targeted elimination of the embolic source, with few systemic side effects and without the need for general anesthesia. However, currently available carotid devices are designed to treat stenotic lesions, and thus are not optimally designed for SyNC. Developing a device specifically tailored to SyNC could be an important step towards establishing endovascular SyNC treatment in clinical practice. In this review, we provide an overview of the current state of evidence with regard to epidemiological, clinical and imaging features of SyNC, propose a SyNC definition based on imaging and clinical features, and outline a possible pathway towards evidence-based SyNC therapies, with a special focus on endovascular SyNC treatment.

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Section: Sync Definitionmentioning

confidence: 99%

Section: Risk Of Stroke In Sync Patientsmentioning

confidence: 99%

Section: Risk Of Stroke In Sync Patientsmentioning

confidence: 99%

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Symptomatic non-stenotic carotid disease: current challenges and opportunities for diagnosis and treatment

Ospel

Kappelhof

Ganesh

et al. 2023

J NeuroIntervent Surg

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“…The aim of this study, which is a sub-study of the Plaque At RISK study (PARISK), is to investigate if there is such an association between each plaque characteristic individually with the leukocyte count in patients with a symptomatic ICAS of <70% [ 10 ]. The PARISK main paper showed that IPH and the total plaque volume can predict recurrent ipsilateral ischemic stroke in patients with ICAS <70% with hazard ratios of 2.12 (95% CI, 1.02–4.44) and 1.07 (1.00–1.15) (per 100 μL increase in volume), respectively [ 11 ]. The PARISK main paper emphasizes the high risk that is associated with IPH.…”

Section: Introductionmentioning

confidence: 99%

Higher Leukocyte Count Is Associated with Lower Presence of Carotid Lipid-Rich Necrotic Core: A Sub-Study in the Plaque at RISK (PARISK) Study

Velzen

Stolp

Dam-Nolen

et al. 2023

JCM

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Background: Increasing evidence suggests that inflammation inside the vessel wall has a prominent role in atherosclerosis. In carotid atherosclerosis in particular, vulnerable plaque characteristics are strongly linked to an increased stroke risk. An association between leukocytes and plaque characteristics has not been investigated before and could help with gaining knowledge on the role of inflammation in plaque vulnerability, which could contribute to a new target for intervention. In this study, we investigated the association of the leukocyte count with carotid vulnerable plaque characteristics. Methods: All patients from the Plaque At RISK (PARISK) study whom had complete data on their leukocyte count and CTA- and MRI-based plaque characteristics were included. Univariable logistic regression was used to detect associations of the leukocyte count with the separate plaque characteristics (intra-plaque haemorrhage (IPH), lipid-rich-necrotic core (LRNC), thin or ruptured fibrous cap (TRFC), plaque ulceration and plaque calcifications). Subsequently, other known risk factors for stroke were included as covariates in a multivariable logistic regression model. Results: 161 patients were eligible for inclusion in this study. Forty-six (28.6%) of these patients were female with a mean age of 70 [IQR 64–74]. An association was found between a higher leukocyte count and lower prevalence of LRNC (OR 0.818 (95% CI 0.687–0.975)) while adjusting for covariates. No associations were found between the leucocyte count and the presence of IPH, TRFC, plaque ulceration or calcifications. Conclusions: The leukocyte count is inversely associated with the presence of LRNC in the atherosclerotic carotid plaque in patients with a recently symptomatic carotid stenosis. The exact role of leukocytes and inflammation in plaque vulnerability deserves further attention.

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“…Current risk assessment and treatment decision strategies for patients with carotid artery stenosis due to the presence of a carotid plaque who suffered a recent transient ischemic attack (TIA) or stroke are based on the degree of CA stenosis [2]. However, recent studies have shown that plaque morphology and composition can improve stroke prediction [3,4,5,6].…”

Section: Introductionmentioning

confidence: 99%

UR-CarA-Net: A Cascaded Framework With Uncertainty Regularization for Automated Segmentation of Carotid Arteries on Black Blood MR Images

Lavrova¹,

Salahuddin

Woodruff

et al. 2023

IEEE Access

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We present a fully automated method for carotid artery (CA) outer wall segmentation in black blood MRI using partially annotated data and compare it to the state-of-the-art reference model. Our model was trained and tested on multicentric data of patients (106 and 23 patients, respectively) with a carotid plaque and was validated on different MR sequences (24 patients) as well as data that were acquired with MRI systems of a different vendor (34 patients). A 3D nnU-Net was trained on pre-contrast T1w turbo spin echo (TSE) MR images. A CA centerline sliding window approach was chosen to refine the nnU-Net segmentation using an additionally trained 2D U-Net to increase agreement with manual annotations. To improve segmentation performance in areas with semantically and visually challenging voxels, Monte-Carlo dropout was used. To increase generalizability, data were augmented with intensity transformations. Our method achieves stateof-the-art results yielding a Dice similarity coefficient (DSC) of 91.7% (interquartile range (IQR) 3.3%) and volumetric intraclass correlation (ICC) with ground truth of 0.90 on the development domain data and a DSC of 91.1% (IQR 7.2%) and volumetric ICC with ground truth of 0.83 on the external domain data outperforming top-ranked methods for open-source CA segmentation. The uncertainty-based approach increases the interpretability of the proposed method by providing an uncertainty map together with the segmentation.

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Carotid Plaque Characteristics Predict Recurrent Ischemic Stroke and TIA

Cited by 40 publications

References 41 publications

Symptomatic non-stenotic carotid disease: current challenges and opportunities for diagnosis and treatment

Symptomatic non-stenotic carotid disease: current challenges and opportunities for diagnosis and treatment

Higher Leukocyte Count Is Associated with Lower Presence of Carotid Lipid-Rich Necrotic Core: A Sub-Study in the Plaque at RISK (PARISK) Study

UR-CarA-Net: A Cascaded Framework With Uncertainty Regularization for Automated Segmentation of Carotid Arteries on Black Blood MR Images

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