Surrogate Markers and Reporting Standards for Outcome After Carotid Intervention

Rots, Marjolijn L.; Lugt, Aad van der; Borst, Gert J. de

doi:10.1016/j.ejvs.2019.08.023

Cited by 8 publications

(10 citation statements)

References 12 publications

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“…Future research should focus on how pre-operative baseline imaging can be used to determine the optimal treatment strategy. 29 Such studies should also focus on the relationship between WML and other promising imaging markers such as (silent) ischaemic brain lesions, which have been associated with poor outcome and WMLs. 30,31 Studies should report predictive value of both ipsi-and contralateral cerebral lesions, should investigate methods for easy identification and quantification of lesions, and should stratify symptomatic from asymptomatic patients in their analysis.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Cerebral Small Vessel Disease in Standard Pre-operative Imaging Reports Is Independently Associated with Increased Risk of Cardiovascular Death Following Carotid Endarterectomy

Timmerman

Rots

Koeverden

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThis study investigated the clinical relevance of reported cerebral small vessel disease (SVD, including white matter lesions and lacunar infarcts) for post-operative stroke and death risk in symptomatic patients undergoing carotid endarterectomy (CEA). The study highlights that the presence of SVD in standard routine pre-operative brain imaging reports identifies patients at high risk of cardiovascular death. Yet, reported SVD is not associated with procedural or long term post-operative stroke risk and therefore this should not influence the decision whether CEA should be performed in symptomatic patients with high degree carotid artery stenosis.Objective: Cerebral white matter lesions (WMLs) and lacunar infarcts are surrogates of cerebral small vessel disease (SVD). WML severity as determined by trained radiologists predicts post-operative stroke or death in patients undergoing carotid endarterectomy (CEA). It is unknown whether routine pre-operative brain imaging reports as part of standard clinical practice also predict short and long term risk of stroke and death after CEA. Methods: Consecutive patients from the Athero-Express biobank study that underwent CEA for symptomatic high degree stenosis between March 2002 and November 2014 were included. Pre-operative brain imaging (computed tomography [CT] or magnetic resonance imaging [MRI]) reports were reviewed for reporting of SVD, defined as WMLs or any lacunar infarcts. The primary outcome was defined as any stroke or any cardiovascular death over three year follow up. The secondary outcome was defined as the 30 day perioperative risk of stroke or cardiovascular death. Results: A total of 1038 patients were included (34% women), of whom 659 (63.5%) had CT images and 379 (36.5%) MRI images available. Of all patients, 697 (67%) had SVD reported by radiologists. Patients with SVD had a higher three year risk of cardiovascular death than those without (6.5% vs. 2.1%, adjusted HR 2.52 [95% CI 1.12e5.67]; p ¼ .026) but no association was observed for the three year risk of stroke (9.0% vs. 6.7%, for patients with SVD vs. those without, adjusted HR 1.24 [95% CI 0.76e2.02]; p ¼ .395). No differences in 30 day peri-operative risk were observed for stroke (4.4% vs. 2.9%, for patients with vs. those without SVD; adjusted HR 1.49 [95% CI 0.73e3.05]; p ¼ .28), and for the combined stroke/cardiovascular death risk (4.4% vs. 3.5%, adjusted HR 1.20 [95% CI 0.61e2.35]; p ¼ .59). Conclusion: Presence of SVD in pre-operative brain imaging reports can serve as a predictor for the three year risk of cardiovascular death in symptomatic patients undergoing CEA but does not predict peri-operative or long term risk of stroke.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Cerebral Small Vessel Disease in Standard Pre-operative Imaging Reports Is Independently Associated with Increased Risk of Cardiovascular Death Following Carotid Endarterectomy

Timmerman

Rots

Koeverden

et al. 2020

European Journal of Vascular and Endovascular Surgery

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“…11 In CAS patients, higher age, plaque vulnerability, and complex carotid/aortic arch anatomy have been identified as risk factors. 3,12 In mostly symptomatic patients, new ischemic brain lesions were identified on repeat examination at 24 to 48 hours after 4 (12.9%) TCAR versus 11 TFCAS procedures (33.3%; P=0.03). Unfortunately, the timing of the intervention (relative to the index event) was not reported.…”

Section: See Related Article P 100mentioning

confidence: 99%

Transcarotid Artery Stenting: Hype or Hope?

Borst

2022

Stroke

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“…Other post-hoc analysis illustrated that plaque composition varied by clinical presentation and type of index event, showing that patients with ocular ischemic events had comparable plaque characteristics to asymptomatic patients, and had relatively less vulnerable plaque characteristics compared to patients with recent stroke or transient ischemic attack (TIA) (18). In addition to clinical symptoms, high risk plaques were also associated with the presence of silent ischemic brain lesions on imaging which are increasingly proposed as surrogate marker for stroke (19). A recent retrospective AE study investigated the presence of silent brain lesions on magnetic resonance diffusion weighted imaging (MR-DWI) during the waiting period between index event and CEA.…”

Section: Translation Of Ex Vivo Plaque Characterization Into In Vivo Examinationmentioning

confidence: 99%

“…DWI lesions represent acute ischemic brain areas that can be detected on brain imaging within minutes after a hypoxic event and remain visible for several days (19). The MRI substudy within International Carotid Stenting Study (ICSS) demonstrated that patients in the CAS group with DWI positive scans had a significantly higher risk on any recurrent stroke or TIA than patients with DWI negative scans (68).…”

Section: Diffusion Weighted Imaging (Dwi)mentioning

confidence: 99%

A narrative review of plaque and brain imaging biomarkers for stroke risk stratification in patients with atherosclerotic carotid artery disease

Donners¹,

Toorop²,

Kleijn³

et al. 2021

Ann Transl Med

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In this narrative review, we aim to review imaging biomarkers that carry the potential to noninvasively guide stroke risk stratification for treatment optimization.Background: Carotid atherosclerosis plays a fundamental part in the occurrence of ischemic stroke.International guidelines select the optimal treatment strategy still mainly based on the presence of clinical symptoms and the degree of stenosis for stroke prevention in patients with atherosclerotic carotid plaques. These guidelines, based on randomized controlled trials that were conducted three decades ago, recommend carotid revascularization in symptomatic patients with high degree of stenosis versus a conservative approach for most asymptomatic patients. Due to optimization of best medical therapy and risk factor control, it is suggested that a subgroup of symptomatic patients is at lower risk of stroke and may not benefit from revascularization, whereas a selective subgroup of high-risk asymptomatic patients would benefit from this procedure.Methods: A literature search was performed for articles published up to December 2020 using PubMed, EMBASE and Scopus. Based on the literature found, change in stenosis degree and volume, plaque echolucency, plaque surface, intraplaque haemorrhage, lipid-rich necrotic core, thin fibrous cap, inflammation, neovascularization, microembolic signals, cerebrovascular reserve, intracranial collaterals, silent brain infarcts, diffusion weighted imaging lesions and white matters lesions have the potential to predict stroke risk. Conclusions:The applicability of imaging biomarkers needs to be further improved before the potential synergistic prognostic ability of imaging biomarkers can be verified on top of the clinical biomarkers. In the future, the routine and combined assessment of both plaque and brain imaging biomarkers might help to improve optimization of treatment strategies in individual patients with atherosclerotic carotid artery disease.

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Surrogate Markers and Reporting Standards for Outcome After Carotid Intervention

Cited by 8 publications

References 12 publications

Cerebral Small Vessel Disease in Standard Pre-operative Imaging Reports Is Independently Associated with Increased Risk of Cardiovascular Death Following Carotid Endarterectomy

Cerebral Small Vessel Disease in Standard Pre-operative Imaging Reports Is Independently Associated with Increased Risk of Cardiovascular Death Following Carotid Endarterectomy

Transcarotid Artery Stenting: Hype or Hope?

A narrative review of plaque and brain imaging biomarkers for stroke risk stratification in patients with atherosclerotic carotid artery disease

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