Key result
The combination of plaque echolucency and embolic signals at baseline was associated with a markedly increased risk of ipsilateral stroke (HR 10.61; 95% CI 2.98-37.82; p=0.0003).
Why the study?
Does the combination of ultrasonic plaque echolucency and embolic signals predict ipsilateral stroke in patients with asymptomatic carotid stenosis ≥70%?
Observational (n=435)
Yes
Does the combination of ultrasonic plaque echolucency and embolic signals predict ipsilateral stroke in patients with asymptomatic carotid stenosis ≥70%?
Hazard Ratio: 10.61 (95% CI 2.98–37.82)
p-value: p=0.0003
The combination of plaque echolucency and embolic signals on ultrasound strongly predicts ipsilateral stroke in asymptomatic carotid stenosis, identifying a high-risk group that may benefit from endarterectomy.
May support risk stratification in asymptomatic carotid stenosis; leaves open whether intervention improves outcomes in this subgroup.
OBJECTIVES: Better methods are required to identify patients with asymptomatic carotid stenosis (ACS) at risk of future stroke. Two potential markers of high risk are echolucent plaque morphology on carotid ultrasound and embolic signals (ES) in the ipsilateral middle cerebral artery on transcranial Doppler ultrasound (TCD). We explored the predictive value of a score based on these 2 measures in the prospective, observational, international multicenter Asymptomatic Carotid Emboli Study. METHODS: A total of 435 recruited subjects with ACS ≥70% had baseline ultrasound images and TCD data available. Subjects were prospectively followed up for 2 years. RESULTS: A total of 164 (37.7%) plaques were graded as echolucent. Plaque echolucency at baseline was associated with an increased risk of ipsilateral stroke alone (hazard ratio [HR] 6.43, 95% confidence interval [CI] 1.36-30.44, p = 0.019). A combined variable of plaque echolucency and ES positivity at baseline was associated with a markedly increased risk of ipsilateral stroke alone (HR 10.61, 95% CI 2.98-37.82, p = 0.0003). This association remained significant after controlling for risk factors, degree of carotid stenosis, and antiplatelet medication. CONCLUSIONS: Plaque morphology assessed using a simple, and clinically applicable, visual rating scale predicts ipsilateral stroke risk in ACS. The combination of ES detection and plaque morphology allows a greater prediction than either measure alone and identifies a high-risk group with an annual stroke risk of 8%, and a low-risk group with a risk of <1% per annum. This risk stratification may prove useful in the selection of patients with ACS for endarterectomy.
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Topakian et al. (2011) conducted an observational in Asymptomatic carotid stenosis (ACS) (n=435). Plaque echolucency and embolic signals (ES) positivity vs. Absence of plaque echolucency and ES positivity was evaluated on Ipsilateral stroke alone (HR 10.61, 95% CI 2.98-37.82, p=0.0003). The combination of plaque echolucency and embolic signals at baseline was associated with a markedly increased risk of ipsilateral stroke (HR 10.61; 95% CI 2.98-37.82; p=0.0003).
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