Clinical features and long-term outcomes of symptomatic low-grade carotid stenosis

Kurosaki, Yoshitaka; Kinosada, Masanori; Ikeda, Hiroyuki; Yamashita, Hiroya; Yoshida, Kazumichi; Chin, Masaki

doi:10.1016/j.jstrokecerebrovasdis.2022.106779

Cited by 3 publications

(5 citation statements)

References 24 publications

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“…26 Kurosaki et al (2022) also reported that about 40% of patients with mild carotid stenosis experienced recurrent ischemic events (annual risk, 8.4%). 18 Recent meta-analysis has analyzed the risk for ipsilateral ischemic stroke and any operative stroke or death in patients with mild carotid stenosis. As the results, the annual risk in medically treated patients was 3.0% in patients with 30-49% stenosis and 1.8% in those with <30% stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…(2012) medically followed up 25 patients with symptomatic mild carotid stenosis due to unstable plaque and found that 46% of them developed recurrent ischemic events (annual risk, 17.8%). 26 Kurosaki et al (2022) also reported that about 40% of patients with mild carotid stenosis experienced recurrent ischemic events (annual risk, 8.4%). 18 Recent meta-analysis has analyzed the risk for ipsilateral ischemic stroke and any operative stroke or death in patients with mild carotid stenosis.…”

Section: Treatment Outcomementioning

confidence: 98%

“…17 IPH and positive remodeling are found in about 60% of patients with symptomatic, mild carotid stenosis. 18 Unstable plaque can be found in 10/11 patients who underwent CEA for All rights reserved. No reuse allowed without permission.…”

Section: Radiological Findingsmentioning

confidence: 99%

“…The copyright holder for this preprint this version posted May 4, 2024. ; https://doi.org/10.1101/2024.05.02.24306793 doi: medRxiv preprint of CEA in patients with symptomatic mild carotid stenosis. 14,17,18,28,29 On the other hands, unstable plaque has recently been recognized as a potential biomarker to represent systemic inflammation and thus predict subsequent cardiovascular events. [30][31][32] In very near future, therefore, the evaluation of plaque composition would be an essential examination to predict the risk of further events and to determine treatment strategies in each patient with symptomatic mild carotid stenosis.…”

Section: Treatment Outcomementioning

confidence: 99%

“…17 IPH and positive remodeling are found in about 60% of patients with symptomatic, mild carotid stenosis. 18 Unstable plaque can be found in 10/11 patients who underwent CEA for symptomatic mild carotid stenosis. 19 Therefore, a majority of patients with symptomatic, mild carotid stenosis should be recognized as having unstable plaques.…”

Section: Radiological Findingsmentioning

confidence: 99%

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Clinical Features, Radiological Findings, and Outcome in Patients with Symptomatic Mild (<50%) Carotid Stenosis: A MUSIC Study

Kashiwazaki,

Chida,

Yoshida

et al. 2024

Preprint

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Background and Purpose – Plaque composition, but not stenosis degree, may play a key role in the development of recurrent ischemic events in patients with symptomatic, mild (<50%) carotid stenosis. This multi-center prospective cohort study was aimed to determine their clinical and radiological features and to evaluate the benefits of carotid endarterectomy (CEA) for them. Methods ? This study included 124 patients with cerebrovascular or retinal ischemic events ipsilateral to mild carotid stenosis. Best medical therapy (BMT) was administered to all participants. CEA or carotid artery stenting (CAS) was implemented at each institution's discretion. Baseline and 6-, 12-, and 24-month follow-up data were collected. Primary endpoint was ipsilateral ischemic stroke. Secondary endpoints included any stroke, ipsilateral TIA, ipsilateral ocular symptoms, any death, and plaque progression requiring CEA/CAS. Multivariate Cox proportional hazard model was used to evaluate the predictors for each endpoint. Results – Of 124 patients, 70 patients (56.5%) had the history of ipsilateral ischemic stroke and 51 (43.5%) had been treated with antiplatelet agents. Mean stenosis degree was 22.4±13.7%. Plaque composition was categorized into fibrous plaque in 22 patients, lipid-rich/necrotic core (LR/NC) in 25, and intraplaque hemorrhage (IPH) in 69. BMT was indicated for 59 patients, while CEA was performed in 63. The incidence of primary endpoint was significantly higher in BMT group than in CEA group (15.1% vs. 1.7%; HR, 0.18; 95%CI, 0.05–0.84, P=0.03). The predictors for ipsilateral ischemic stroke were CEA (HR, 0.18; 95%CI, 0.05–0.84, P=0.03) and IPH (HR, 1.92; 95%CI, 1.26–4.28, P=0.04). The results on secondary endpoints were very similar. Conclusion – IPH may highly predict subsequent cerebrovascular events, whereas CEA may reduce these risk during a 2-year follow-up in patients with symptomatic, mild carotid stenosis. Randomized clinical trials is warranted to validate these results.

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Section: Discussionmentioning

confidence: 99%

Section: Treatment Outcomementioning

confidence: 98%

Section: Radiological Findingsmentioning

confidence: 99%

Section: Treatment Outcomementioning

confidence: 99%

“…17 IPH and positive remodeling are found in about 60% of patients with symptomatic, mild carotid stenosis. 18 Unstable plaque can be found in 10/11 patients who underwent CEA for symptomatic mild carotid stenosis. 19 Therefore, a majority of patients with symptomatic, mild carotid stenosis should be recognized as having unstable plaques.…”

Section: Radiological Findingsmentioning

confidence: 99%

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Clinical Features, Radiological Findings, and Outcome in Patients with Symptomatic Mild (<50%) Carotid Stenosis: A MUSIC Study

Kashiwazaki,

Chida,

Yoshida

et al. 2024

Preprint

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Plaque Ulcerations are Associated with Recurrence in Symptomatic Low-Grade Carotid Stenosis

Shimonaga,

Ikedo,

Yamada

et al. 2024

World Neurosurgery

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Association between Pericarotid Fat Density and Positive Remodeling in Patients with Carotid Artery Stenosis

Kashiwazaki,

Yamamoto,

Akioka

et al. 2024

JCM

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Background/Objectives: The underlying mechanism of the potential involvement of inflammatory crosstalk between pericarotid fat and vascular layers in atherosclerosis pathogenesis is unclear. We investigated the association between pericarotid fat density and positive remodeling and inflammatory markers in carotid stenosis. We hypothesized that pericarotid fat density might serve as a marker of plaque inflammation in a clinical setting. Methods: We evaluated the stenosis degree and pericarotid fat density in 258 patients with carotid plaques. Plaque composition was examined, and the correlation between pericarotid fat density and expansive remodeling was investigated. Pearson’s product–moment correlation coefficient was used to examine the relationship between pericarotid fat density and the expansive remodeling ratio. We also evaluated the relationship of pericarotid fat density with plaque composition, degree of stenosis, and macrophage and microvessel counts by. The subgroup analysis compared these factors between symptomatic mild carotid stenosis. Results: The pericarotid fat density was −63.0 ± 11.1 HU. The carotid fat densities were −56.8 ± 10.4 HU in symptomatic and −69.2 ± 11.4 HU in asymptomatic lesions. The pericarotid fat density values in intraplaque hemorrhage, lipid-rich necrotic core, and fibrous plaque were −51.6 ± 10.4, −59.4 ± 12.8, and −74.2 ± 8.4 HU, respectively. Therefore, the expansive remodeling ratio was 1.64 ± 0.4. Carotid fat density and expansive remodeling ratio were correlated. Immunohistochemistry showed high macrophage and microvessel levels (143.5 ± 61.3/field and 121.2 ± 27.7/field, respectively). In symptomatic mild carotid stenosis, pericarotid fat density was correlated with other inflammatory factors. The pericarotid fat density and expansive remodeling ratio (2.08 ± 0.21) were high in mild stenosis (−50.1 ± 8.4 HU). Conclusions: Pericarotid fat and intraplaque components were well correlated. Carotid fat density may be a marker of plaque inflammation in carotid plaques.

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Clinical features and long-term outcomes of symptomatic low-grade carotid stenosis

Cited by 3 publications

References 24 publications

Clinical Features, Radiological Findings, and Outcome in Patients with Symptomatic Mild (<50%) Carotid Stenosis: A MUSIC Study

Clinical Features, Radiological Findings, and Outcome in Patients with Symptomatic Mild (<50%) Carotid Stenosis: A MUSIC Study

Plaque Ulcerations are Associated with Recurrence in Symptomatic Low-Grade Carotid Stenosis

Association between Pericarotid Fat Density and Positive Remodeling in Patients with Carotid Artery Stenosis

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