Complicated Carotid Artery Plaques as a Cause of Cryptogenic Stroke

Kopczak, Anna; Schindler, Andreas; Bayer-Karpinska, Anna; Koch, Mia L.; Sepp, Dominik; Zeller, MA Julia; Strecker, Christoph; Hempel, Johann-Martin; Yuan, Chun; Malik, Rainer; Wollenweber, Frank Arne; Boeckh‐Behrens, Tobias; Cyran, Clemens C.; Helck, Andreas; Harloff, Andreas; Ziemann, Ulf; Poli, Sven; Poppert, Holger; Dichgans, Martin; Saam, Tobias

doi:10.1016/j.jacc.2020.09.532

Cited by 77 publications

(82 citation statements)

References 33 publications

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“…30 As one example, this combined application may be useful among subjects who are diagnosed with cryptogenic stroke to rule out if a subset of them may have underlying carotid lesions without significant stenosis. 7 Although some DL-based quantitative vessel wall analysis algorithms exist for vessel wall analysis, 31,32 LATTE is unique as a fully automated and domain adaptive atherosclerotic lesion analysis workflow. Developed from a large training set and validated on four diverse datasets with good agreements on 271 subjects from eight sites, LATTE has overcome several obstacles in computer assisted vessel wall analysis, including determining image quality, identifying the location of the artery in complicated image patterns in VWI, and classifying lesions accurately across domains.…”

Section: Discussionmentioning

confidence: 99%

“…4 Luminal narrowing through angiographic approaches, such as Doppler ultrasound and CT angiography, have been used clinically to evaluate severity of carotid atherosclerosis but recent studies have shown its limitations in identifying high-risk plaques that may cause clinical events and may miss potential embolic sources of carotid atherosclerosis and miscategorize the etiology of stroke. [5][6][7] Vessel wall imaging (VWI) with MRI of the carotid artery has been recognized to be able to identify high-risk atherosclerotic lesions and may improve diagnosis sensitivity and accuracy. [8][9][10] However, traditional axial acquisition MRI sequences require a long scanning time.…”

Section: Introductionmentioning

confidence: 99%

“…Atherosclerotic lesion progression leads to plaque rupture, arterial stenosis, and/or occlusion, which may cause ischemic events due to atheroembolization or hypoperfusion 4 . Luminal narrowing through angiographic approaches, such as Doppler ultrasound and CT angiography, have been used clinically to evaluate severity of carotid atherosclerosis but recent studies have shown its limitations in identifying high‐risk plaques that may cause clinical events and may miss potential embolic sources of carotid atherosclerosis and miscategorize the etiology of stroke 5‐7 …”

Section: Introductionmentioning

confidence: 99%

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Domain adaptive and fully automated carotid artery atherosclerotic lesion detection using an artificial intelligence approach (LATTE) on 3D MRI

Chen

Zhao

Jiang

et al. 2021

Magnetic Resonance in Med

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Purpose To develop and evaluate a domain adaptive and fully automated review workflow (lesion assessment through tracklet evaluation, LATTE) for assessment of atherosclerotic disease in 3D carotid MR vessel wall imaging (MR VWI). Methods VWI of 279 subjects with carotid atherosclerosis were used to develop LATTE, mainly convolutional neural network (CNN)‐based domain adaptive lesion classification after image quality assessment and artery of interest localization. Heterogeneity in test sets from various sites usually causes inferior CNN performance. With our novel unsupervised domain adaptation (DA), LATTE was designed to accurately classify arteries into normal arteries and early and advanced lesions without additional annotations on new datasets. VWI of 271 subjects from four datasets (eight sites) with slightly different imaging parameters/signal patterns were collected to assess the effectiveness of DA of LATTE using the area under the receiver operating characteristic curve (AUC) on all lesions and advanced lesions before and after DA. Results LATTE had good performance with advanced/all lesion classification, with the AUC of >0.88/0.83, significant improvements from >0.82/0.80 if without DA. Conclusions LATTE can locate target arteries and distinguish carotid atherosclerotic lesions with consistently improved performance with DA on new datasets. It may be useful for carotid atherosclerosis detection and assessment on various clinical sites.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Domain adaptive and fully automated carotid artery atherosclerotic lesion detection using an artificial intelligence approach (LATTE) on 3D MRI

Chen

Zhao

Jiang

et al. 2021

Magnetic Resonance in Med

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“…Most patients with high-grade stenosis remain asymptomatic, whereas a significant number with minor stenosis become symptomatic. 22 Therefore, factors other than the degree of stenosis must be important determinants or markers of an “active” carotid lesion. The search for these factors began with attempts to correlate plaque characteristics identified primarily during surgery or postmortem examinations in patients with the presence or absence of ischemic symptoms and events.…”

Section: Histopathologic Studiesmentioning

confidence: 99%

“… 45 Conversely, there exist a substantial proportion of patients with <50% stenosis who have anterior circulation strokes. 22 A number of studies have demonstrated that up to 20% of patients with cryptogenic stroke or embolic stroke of undetermined source have only mild carotid stenosis. Among these patients, the risk of recurrent ipsilateral stroke is as high as 8% at 3 years.…”

Section: Features Of Plaque Vulnerabilitymentioning

confidence: 99%

Review of imaging biomarkers for the vulnerable carotid plaque

Saba

Agarwal

Cau

et al. 2021

JVS-Vascular Science

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Identification of carotid artery atherosclerosis is conventionally based on measurements of luminal stenosis. However, histopathologic studies demonstrate considerable differences between plaques with identical degrees of stenosis and indicate that certain plaque features are associated with increased risk for ischemic events. As a result of the rapid technological evolution in medical imaging, several important steps have been taken in the field of carotid plaque imaging allowing us to visualize the carotid atherosclerotic plaque and its composition in great detail. For computed tomography, magnetic resonance imaging, positron emission tomography, and ultrasound scan, evidence has accumulated on novel imaging-based markers that confer information on carotid plaque vulnerability, such as intraplaque hemorrhage and lipid-rich necrotic cores. In terms of the imaging-based identification of individuals at high risk of stroke, routine assessments of such imaging markers are the way forward for improving current clinical practice. The current review highlights the main characteristics of the vulnerable plaque indicating their role in the etiology of ischemic stroke as identified by intensive plaque imaging.

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Apixaban to Prevent Recurrence After Cryptogenic Stroke in Patients With Atrial Cardiopathy

Kamel,

Longstreth,

Tirschwell

et al. 2024

JAMA

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ImportanceAtrial cardiopathy is associated with stroke in the absence of clinically apparent atrial fibrillation. It is unknown whether anticoagulation, which has proven benefit in atrial fibrillation, prevents stroke in patients with atrial cardiopathy and no atrial fibrillation.ObjectiveTo compare anticoagulation vs antiplatelet therapy for secondary stroke prevention in patients with cryptogenic stroke and evidence of atrial cardiopathy.Design, Setting, and ParticipantsMulticenter, double-blind, phase 3 randomized clinical trial of 1015 participants with cryptogenic stroke and evidence of atrial cardiopathy, defined as P-wave terminal force greater than 5000 μV × ms in electrocardiogram lead V1, serum N-terminal pro-B-type natriuretic peptide level greater than 250 pg/mL, or left atrial diameter index of 3 cm/m2 or greater on echocardiogram. Participants had no evidence of atrial fibrillation at the time of randomization. Enrollment and follow-up occurred from February 1, 2018, through February 28, 2023, at 185 sites in the National Institutes of Health StrokeNet and the Canadian Stroke Consortium.InterventionsApixaban, 5 mg or 2.5 mg, twice daily (n = 507) vs aspirin, 81 mg, once daily (n = 508).Main Outcomes and MeasuresThe primary efficacy outcome in a time-to-event analysis was recurrent stroke. All participants, including those diagnosed with atrial fibrillation after randomization, were analyzed according to the groups to which they were randomized. The primary safety outcomes were symptomatic intracranial hemorrhage and other major hemorrhage.ResultsWith 1015 of the target 1100 participants enrolled and mean follow-up of 1.8 years, the trial was stopped for futility after a planned interim analysis. The mean (SD) age of participants was 68.0 (11.0) years, 54.3% were female, and 87.5% completed the full duration of follow-up. Recurrent stroke occurred in 40 patients in the apixaban group (annualized rate, 4.4%) and 40 patients in the aspirin group (annualized rate, 4.4%) (hazard ratio, 1.00 [95% CI, 0.64-1.55]). Symptomatic intracranial hemorrhage occurred in 0 patients taking apixaban and 7 patients taking aspirin (annualized rate, 1.1%). Other major hemorrhages occurred in 5 patients taking apixaban (annualized rate, 0.7%) and 5 patients taking aspirin (annualized rate, 0.8%) (hazard ratio, 1.02 [95% CI, 0.29-3.52]).Conclusions and RelevanceIn patients with cryptogenic stroke and evidence of atrial cardiopathy without atrial fibrillation, apixaban did not significantly reduce recurrent stroke risk compared with aspirin.Trial RegistrationClinicalTrials.gov Identifier: NCT03192215

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Complicated Carotid Artery Plaques as a Cause of Cryptogenic Stroke

Cited by 77 publications

References 33 publications

Domain adaptive and fully automated carotid artery atherosclerotic lesion detection using an artificial intelligence approach (LATTE) on 3D MRI

Domain adaptive and fully automated carotid artery atherosclerotic lesion detection using an artificial intelligence approach (LATTE) on 3D MRI

Review of imaging biomarkers for the vulnerable carotid plaque

Apixaban to Prevent Recurrence After Cryptogenic Stroke in Patients With Atrial Cardiopathy

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