The Causes and Risk of Stroke in Patients with Asymptomatic Internal-Carotid-Artery Stenosis

Inzitari, Domenico; Eliasziw, Michael; Gates, Peter; Sharpe, B. L.; Chan, Richard; Meldrum, Heather; Barnett, H. J. M.

doi:10.1056/nejm200006083422302

Cited by 639 publications

(401 citation statements)

References 40 publications

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“…In fact, data from NASCET trial showed that carotid endarterectomy is more beneficial in patients with intracranial stenosis. 18 Similarly, lacunar strokes were included as endpoint as they had been associated with a poor hemodynamic response in patients with carotid stenosis. 11 Another point to discuss is the relatively high incidence of stroke in our cohort compared with more recent studies.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic Markers of Vascular Risk in Patients with Asymptomatic Carotid Stenosis

Silvestrini

Altamura

Cerqua

et al. 2013

J Cereb Blood Flow Metab

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Six-hundred twenty-one subjects with unilateral asymptomatic severe internal carotid artery (ICA) stenosis were prospectively evaluated with a median follow-up of 27 months (min ¼ 6, max ¼ 68). Vascular risk profile, plaque characteristic, stenosis progression, and common carotid artery intima-media thickness (IMT) were investigated in all patients. Outcome measures were occurrence of ischemic stroke ipsilateral to ICA stenosis and vascular death, while myocardial infarction, contralateral strokes, and transient ischemic attack were considered as competing events. A total of 99 subjects (15.9%) suffered from a vascular event. Among them, 39 were strokes ipsilateral to the stenosis (6.3%). Degree of stenosis, stenosis progression, and common carotid artery IMT resulted as independent predictive factors of ipsilateral stroke. Considering a stenosis of 60% to 70% as reference, a degree between 71% and 90% increased the risk by 2.45, while a degree between 91% and 99% increased the risk by 3.26. The progression of stenosis was a strong risk factor (hazard ratio ¼ 4.32). Finally, the role of carotid IMT was confirmed as crucial additional measure, with an increased risk by 25% for each 0.1 mm IMT increase. Our data suggest that IMT, stenosis progression and severity should be considered as risk factors for cerebrovascular events in asymptomatic subjects with severe ICA stenosis.

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Section: Discussionmentioning

confidence: 99%

Ultrasonographic Markers of Vascular Risk in Patients with Asymptomatic Carotid Stenosis

Silvestrini

Altamura

Cerqua

et al. 2013

J Cereb Blood Flow Metab

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“…For those with 75% to 94% stenosis, the rates were 27.1% and 18.5%, respectively ( Figure 2). 17 Because NASCET enrolled symptomatic patients, however, understanding the implications of stroke rate on the side of an asymptomatic stenosis opposite a symptomatic stenosis is problematic. 17 The Asymptomatic Carotid Atherosclerosis Study (ACAS) 18 enrolled asymptomatic patients with stenosis Ն60%; even without surgery, absolute stroke rates were low: 5.0% at 2 years with a 1.2% absolute risk reduction by carotid endarterectomy (to 3.8%) by the most highly skilled surgeons available.…”

Section: Cerebrovascular Atherosclerotic Diseasementioning

confidence: 99%

Atherosclerotic Vascular Disease Conference

Pasternak¹,

Criqui²,

Benjamin³

et al. 2004

Circulation

168

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“…The IPH was defined as hyperintense compared to adjacent muscle (signal intensity ratio ≥1.5:1) on SNAP imaging 13. The luminal stenosis was measured using WASID14 criteria for intracranial arteries and NASCET15 criteria for extracranial carotid arteries on SNAP angiography. The presence or absence and the lesion volume of acute ischemic lesions (AIL) on DWI images were evaluated.…”

Section: Methodsmentioning

confidence: 99%

Atherosclerosis in stroke‐related vascular beds and stroke risk: A 3‐D MR vessel wall imaging study

Dai

Cai

et al. 2018

Ann Clin Transl Neurol

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ObjectivesTo investigate the characteristics of atherosclerotic plaques in stroke‐related vascular beds and their relationship with stroke using three‐dimensional magnetic resonance (MR) vessel wall imaging.MethodsFifty‐two symptomatic patients (mean age: 56.3 ± 13.4 years; 38 males) were enrolled and underwent MR vessel wall imaging for stroke‐related vascular beds including intracranial and extracranial carotid arteries and aortic arch and routine MR imaging for brain. The maximum wall thickness (Max WT) and luminal stenosis of each plaque were measured. The presence/absence of atherosclerotic plaque, intraplaque hemorrhage (IPH), and severe stenosis (stenosis >50%) at each vascular bed and acute ischemic lesion (AIL) were determined. The correlation between Max WT of each vascular bed and AIL was analyzed.ResultsOf 52 patients, 24 (46.2%) had AILs, and 30 (57.7%), 34 (65.4%), and 11 (21.2%) had plaques in intracranial artery, extracranial carotid artery, and aortic arch, respectively. The prevalence of IPH and severe stenosis was 25% and 26.9% for intracranial arteries, 13.5% and 9.6% for extracranial carotid artery, and 3.8% and 0% for aortic arch, respectively. In discriminating AIL, Max WT of intracranial artery had the highest area‐under‐the‐curve (AUC = 0.84), followed by extracranial carotid artery (AUC = 0.83) and aortic arch (AUC = 0.78) after adjusted for confounding factors. The AUC of Max WT combined three stroked‐related vascular beds reached 0.87.ConclusionExtracranial carotid arteries have the highest prevalence of plaques and intraplaque hemorrhage and severe stenosis are most frequently seen in intracranial arteries in Asian symptomatic patients. The Max WT combined three stroke‐related vascular beds show stronger predictive value for AIL than each vascular bed alone.

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The Causes and Risk of Stroke in Patients with Asymptomatic Internal-Carotid-Artery Stenosis

Cited by 639 publications

References 40 publications

Ultrasonographic Markers of Vascular Risk in Patients with Asymptomatic Carotid Stenosis

Ultrasonographic Markers of Vascular Risk in Patients with Asymptomatic Carotid Stenosis

Atherosclerotic Vascular Disease Conference

Atherosclerosis in stroke‐related vascular beds and stroke risk: A 3‐D MR vessel wall imaging study

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