Key result
Using SNAP imaging in 2,304 patients, plaques were found in 9.9% of carotid arteries, with 77.8% showing <50% stenosis; among these, 13.3% of patients had a territorial acute focal infarction.
Why the study?
To determine the prevalence of symptomatic nonstenotic carotid disease (SyNC) using simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) imaging as an MR screen protocol in acute stroke and assess carotid plaque imaging findings.
Does simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) imaging identify symptomatic nonstenotic carotid disease in patients with acute stroke?
Observational (n=2,304)
Does simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) imaging identify symptomatic nonstenotic carotid disease in patients with acute stroke?
In patients with acute stroke and <50% carotid stenosis, symptomatic nonstenotic carotid disease is a relatively important source of stroke, with high maximal wall thickness and intraplaque hemorrhage serving as key risk factors.
May identify additional stroke sources in nonstenotic disease; leaves open whether SNAP screening improves outcomes.
Background: To determine the prevalence of symptomatic nonstenotic carotid disease (SyNC) using simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) imaging for patients with acute stroke as an MR screen protocol and to assess imaging findings of carotid plaques. Patients and Methods: From May 2020 to October 2021, 2459 patients with suspected acute neurological symptoms were evaluated with brain diffusion-weighted imaging (DWI) and carotid SNAP imaging. We analyzed the degree of stenosis and intraplaque hemorrhage (IPH) using SNAP imaging. Prevalence of SyNC and risk factors for stroke in patients with SyNC were determined. We performed subgroup multivariate analysis between SyNC and other etiologies of stroke (non-SyNC). Results: Of 4608 carotid arteries in 2304 patients enrolled in this study, 454 (9.9%) plaques (both lesions in 128 patients) were found on SNAP imaging. Of these plaques, 353 (77.8%) showed stenosis of <50%. Of plaques with <50% stenosis, 47 (13.3%) patients had a territorial acute focal infarction. Seventeen (36.2%) were classified with embolic stroke of undetermined source (ESUS) and SyNC. High maximal wall thickness and carotid IPH were identified as influencing factors for SyNC. Conclusion: For patients with <50% stenosis and territorial infarction, SyNC is a relatively important source of stroke. Especially, high maximal wall thickness and carotid IPH are important risk factors for SyNC.
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Lee et al. (2022) conducted an observational in Suspected acute neurological symptoms (n=2,304). Symptomatic nonstenotic carotid disease (SyNC) vs. Other etiologies of stroke (non-SyNC) was evaluated on Prevalence of symptomatic nonstenotic carotid disease (SyNC). Using SNAP imaging in 2,304 patients, plaques were found in 9.9% of carotid arteries, with 77.8% showing <50% stenosis; among these, 13.3% of patients had a territorial acute focal infarction.
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