Key result
In patients with symptomatic low-grade carotid stenosis and T1 high-signal plaque, 53% experienced recurrent ischemic events during a mean follow-up of 28.1 months despite antiplatelet therapy.
Why the study?
Does antiplatelet therapy effectively prevent recurrent ischemic events in patients with symptomatic low-grade carotid stenosis and vulnerable plaque?
Cohort (n=43)
No
Does antiplatelet therapy effectively prevent recurrent ischemic events in patients with symptomatic low-grade carotid stenosis and vulnerable plaque?
Symptomatic low-grade carotid stenosis with vulnerable plaque on MRI carries a high risk of recurrent ischemic events (53%) despite antiplatelet therapy, suggesting carotid endarterectomy may be a necessary and safe alternative for these high-risk patients.
High recurrent ischemic risk observed on antiplatelet therapy in this cohort; leaves open whether revascularization improves outcomes in symptomatic low-grade stenosis with vulnerable plaque.
The purpose of this study is to clarify the therapeutic outcomes for symptomatic lowgrade carotid stenosis with vulnerable plaque. We investigated 43 patients with symptomatic lowgrade stenosis (<50%) and a high-signal plaque on T1-weighted imaging. Single antiplatelet therapy (APT) was started, and recurrent ischemic events were treated with dual APT. Carotid endarterectomy (CEA) was considered when recurrence occurred refractory to dual APT. During follow-up (mean, 28.1 ± 23.5 months), 23 of 43 patients (53%) experienced recurrent events. Fifteen of the 26 patients who underwent dual APT had recurrent events. Fourteen patients were treated with CEA, and the complication seen was temporary hoarseness. During postoperative follow-up (mean, 24.8 ± 17.6 months), no patients showed ipsilateral ischemic events. We concluded that symptomatic low-grade carotid stenosis with a high-signal plaque on carotid magnetic resonance imaging tends to be associated with a high risk of recurrent ischemic events, even with dual APT. CEA for symptomatic lowgrade carotid stenosis might be safe and effective.
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Kurosaki et al. (2015) conducted a cohort in Symptomatic low-grade carotid artery stenosis with vulnerable plaque (n=43). Antiplatelet therapy was evaluated on Recurrent ischemic events. In patients with symptomatic low-grade carotid stenosis and T1 high-signal plaque, 53% experienced recurrent ischemic events during a mean follow-up of 28.1 months despite antiplatelet therapy.
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