Risk of Early Recurrent Stroke in Symptomatic Carotid Stenosis

Strömberg, Sofia; Nordanstig, Annika; Bentzel, Tobias; Österberg, Klas; Bergström, Göran

doi:10.1016/j.ejvs.2014.11.004

Cited by 51 publications

(32 citation statements)

References 33 publications

(18 reference statements)

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“…Previous studies have shown that stroke patients are at increased risk for a recurrent stroke compared to patients with an (ocular) TIA [8,9,10]. The results from the present study suggest that differences between adventitial microvasculature of symptomatic patients with (ocular) TIA and minor stroke might exist between these 2 groups.…”

Section: Discussionsupporting

confidence: 46%

“…The risk for a recurrent stroke within 7 days was 5.2% after a TIA versus 11.5% after a stroke [8]. Additional research showed that patients with a minor stroke have an increased risk for a recurrent stroke compared to patients with a recent TIA or ocular TIA (also known as amaurosis fugax) [9]. Data from the European Carotid Surgery Trial also showed that the hazard ratio for a 5-year risk of ipsilateral ischemic stroke depends on the type of the presenting cerebrovascular event [10].…”

Section: Introductionmentioning

confidence: 99%

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Ischemic Stroke Patients Demonstrate Increased Carotid Plaque Microvasculature Compared to (Ocular) Transient Ischemic Attack Patients

Hoof

Schreuder

Nelemans³

et al. 2017

Cerebrovasc Dis

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Background: Patients with a recent ischemic stroke have a higher risk of recurrent stroke compared to (ocular) transient ischemic attack (TIA) patients. Plaque microvasculature is considered as a feature of plaque vulnerability and can be quantified with carotid dynamic contrast-enhanced MRI (DCE-MRI). The purpose of this cross-sectional study was to explore the association between plaque microvasculature and the type of recent cerebrovascular events in symptomatic patients with mild-to-moderate carotid stenosis. Methods: A total of 87 symptomatic patients with a recent stroke (n = 35) or (ocular) TIA (n = 52) underwent carotid DCE-MRI examination. Plaque microvasculature was studied in the vessel wall and adventitia using DCE-MRI and the pharmacokinetic modeling parameter K^trans. Statistical analysis was performed with logistic regression, correcting for associated clinical risk factors. Results: The 75th percentile adventitial (OR 1.97, 95% CI 1.18-3.29) K^trans was significantly associated with a recent ischemic stroke compared to (ocular) TIA in multivariate analysis, while clinical risk factors were not significantly associated with the type of event. Conclusions: This study indicates a positive association of leaky plaque microvasculature with a recent ischemic stroke compared to (ocular) TIA. Prospective longitudinal studies are needed to investigate whether K^trans or other plaque characteristics may serve as an imaging marker for predicting (the type of) future cerebrovascular events.

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Section: Discussionsupporting

confidence: 46%

Section: Introductionmentioning

confidence: 99%

Ischemic Stroke Patients Demonstrate Increased Carotid Plaque Microvasculature Compared to (Ocular) Transient Ischemic Attack Patients

Hoof

Schreuder

Nelemans³

et al. 2017

Cerebrovasc Dis

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show abstract

“…5 In a recent Swedish study, Stromberg reported that 72% of their cohort of patients who presented with a TIA/minor stroke and a 50e99% stenosis were admitted on the day of the referring neurological event. 17 Thereafter, 2% suffered a stroke within 48 hours of their presenting symptom, increasing to 4% at 7 days. When 'strokes in evolution' were included, 3.2% of patients had suffered a stroke within 48 hours.…”

Section: Discussionmentioning

confidence: 99%

Dual Antiplatelet Therapy Prior to Expedited Carotid Surgery Reduces Recurrent Events Prior to Surgery without Significantly Increasing Peri-operative Bleeding Complications

Batchelder

Hunter

Cairns

et al. 2015

European Journal of Vascular and Endovascular Surgery

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“…According to the ethical committee, a consent from the patient is not necessary in this type of retrospective study. Study patients were identified through the Western region Initiative to Gather information on Atherosclerosis database 8. All patients in this study had undergone US between October 1, 2004 and December 31, 2010 at Sahlgrenska University Hospital in Gothenburg and were given the International Classification of Diseases (ICD) code G45.3 (AF) as registered at The National Board of Health and Welfare in Sweden within 6 months prior to the US.…”

Section: Methodsmentioning

confidence: 99%

Amaurosis fugax: risk factors and prevalence of significant carotid stenosis

Kvickström

Lindblom

Bergström

et al. 2016

OPTH

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PurposeThe purpose of this study was to describe clinical characteristics and prevalence of carotid stenosis in patients with amaurosis fugax (AF).MethodPatients diagnosed with AF and subjected to carotid ultrasound in 2004–2010 in Sahlgrenska University Hospital, Gothenburg (n=302), were included, and data were retrospectively collected from medical records.ResultsThe prevalence of significant carotid stenosis was 18.9%, and 14.2% of the subjects were subjected to carotid endarterectomy. Significant associations with risk of having ≥70% stenosis were male sex (adjusted odds ratio [aOR]: 2.62; 95% confidence interval [CI]: 1.26–5.46), current smoking (aOR: 6.26; 95% CI: 2.62–14.93), diabetes (aOR: 3.68; 95% CI: 1.37–9.90) and previous vasculitis (aOR: 10.78; 95% CI: 1.36–85.5). A majority of the patients (81.4%) was seen by an ophthalmologist prior to the first ultrasound. Only 1.7% of the patients exhibited retinal artery emboli at examination.ConclusionThe prevalence of carotid stenosis among patients with AF is higher than has previously been demonstrated in stroke patients. An association with previously reported vascular risk factors and with vasculitis is seen in this patient group. Ocular findings are scarce.

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Risk of Early Recurrent Stroke in Symptomatic Carotid Stenosis

Abstract: The data suggest that the early risk of recurrent stroke in symptomatic significant carotid stenosis is not as high as some earlier studies have shown. The risk is similar to several studies in which a modern medical treatment regime could be assumed.

Cited by 51 publications

References 33 publications

Ischemic Stroke Patients Demonstrate Increased Carotid Plaque Microvasculature Compared to (Ocular) Transient Ischemic Attack Patients

Ischemic Stroke Patients Demonstrate Increased Carotid Plaque Microvasculature Compared to (Ocular) Transient Ischemic Attack Patients

Dual Antiplatelet Therapy Prior to Expedited Carotid Surgery Reduces Recurrent Events Prior to Surgery without Significantly Increasing Peri-operative Bleeding Complications

Amaurosis fugax: risk factors and prevalence of significant carotid stenosis

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