Introduction: Symptomatic Non-stenotic Carotid (SyNC) disease is an increasingly recognized etiology in ischemic stroke, particularly in the presence of certain high-risk plaque features. The aim of this population level clinical-imaging study was to examine the risk of ipsilateral and recurrent stroke in patients with SyNC with 5-year follow-up. In addition, we aimed to identify plaque features that predict higher risk of ipsilateral and recurrent stroke in this population. Methodology: All patients presenting with stroke or transient ischemic attack (TIA) in fiscal year 2019/20 were identified using administrative data. All baseline and follow up imaging within 5-years of presentation was analyzed. CT Angiograms were assessed for plaque features such as degree of stenosis, plaque thickness, calcification, plaque irregularity, ulceration, positive rim sign, and focal vessel caliber increase. Parenchymal imaging was reviewed for infarct presence on the same side as carotid disease (concordant stroke). Analyses were performed at the patient and carotid level comparing 1-50% stenosis versus no stenosis using unadjusted and adjusted (for age and sex) logistic regression analysis. Patients with carotid stenosis >50% were excluded from the analysis. Results: Among 1249 patients presenting with stroke or TIA, 658 (52.7%) patients had 0-50% stenosis. Of the total 658 patients included, 153 (23.5%) had concordant stroke and 76 (11.6%) had recurrent stroke. Of the 76 patients that developed recurrence, 49 (7.4%) patients had SyNC on the ipsilateral side. In adjusted analyses, there was significantly increased odds of concordant stroke at index presentation with 1-50% stenosis aOR 3.56, 95% CI 2.99 – 4.25 and increasing plaque thickness (per mm) aOR 1.19, 95% CI 1.03 – 1.38. Similarly, adjusted analysis showed significant increase in odds of recurrent concordant stroke with 1-50% stenosis aOR 2.39, 95% CI 1.94 – 2.95, plaque thickness aOR 1.32, 95% CI 1.05 – 1.67, and plaque ulceration aOR 3.86, 95% CI 1.31 – 11.35. Conclusion: This retrospective population-level study demonstrates that non-stenotic carotid disease carries a significant risk of ipsilateral and recurrent stroke, particularly with degree of stenosis, increasing plaque thickness, and ulceration. These findings suggest that current risk stratification may underemphasize non-stenotic plaques, warranting further prospective validation to guide monitoring and treatment strategies.
Zahid et al. (Thu,) studied this question.
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