July 16, 2019Frontiers in NeurologyOpen Access

Identification of High Risk Carotid Artery Stenosis: A Multimodal Vascular and Perfusion Imaging Study

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Carotid artery stenosis (n=259). Intervention: Deep white matter hyperintensity (DWMH) vs. Absence of DWMH. Primary outcome: Symptomatic carotid artery stenosis (SCAS) (OR 3.46, 95% CI 1.842-6.682, p=<0.001).

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Key result

Deep white matter hyperintensity (OR 3.46), absent plaque calcification, susceptibility vessel sign, and increased cerebral blood volume were associated with symptomatic carotid artery stenosis.

Why the study?

Risk stratification of asymptomatic carotid artery stenosis remains an issue for carotid revascularization.

Do multimodal imaging markers (plaque calcification, deep white matter hyperintensity, GRE susceptibility vessel sign, increased cerebral blood volume) identify symptomatic status in patients with carotid artery stenosis?

Population

259 patients with carotid artery stenosis who underwent carotid revascularization

Comparison

Asymptomatic vs symptomatic carotid artery stenosis

Design

Retrospective propensity score-matched study

Authors

MPMoo‐Seok Park SKSoonwook Kwon MLMi Ji Lee

Discussion

Member takes

Overview

These markers may aid symptomatic carotid stenosis identification; hypothesis-generating and requires prospective validation before practice change.

Study Design

Type

Observational (n=259)

Multicenter

Structured PICO

Population

259 patients (mean age 69 years, 15% female) with carotid artery stenosis who underwent revascularization procedures, retrospectively analyzed to identify imaging markers of symptomatic status.

Exposure

Multimodal imaging assessment including duplex sonography, computed tomography angiography, brain MRI, MRA, and perfusion-weighted imaging to identify high-risk plaque and perfusion characteristics.

Comparator

Comparison between asymptomatic carotid artery stenosis (ACAS) and symptomatic carotid artery stenosis (SCAS) patients, matched 1:1 using propensity scores.

Outcome

Factors independently associated with symptomatic carotid artery stenosis (SCAS), defined as a cerebral ischemic stroke event during the 6 months before revascularization.surrogate

Main Result

Odds Ratio: 3.46 (95% CI 1.842–6.682)

p-value: p=<0.001

Multimodal imaging markers, including absence of plaque calcification, deep white matter hyperintensity, GRE susceptibility vessel sign, and increased cerebral blood volume, can independently identify high-risk symptomatic carotid artery stenosis.

Limitations

Retrospective design without imaging prior to patients becoming symptomatic
Imaging obtained during or after the acute ischemic period in the symptomatic group
Only included patients who underwent revascularization, introducing potential selection bias
Potential unmeasured confounding factors despite propensity score matching
Retrospective design
No imaging prior to becoming symptomatic (imaging obtained during or after acute ischemic period)
Selection bias (only included patients who underwent revascularization rather than best medical treatment)
Potential unmeasured confounding factors despite propensity matching
Lack of long-term follow-up

Cite This Study

Park et al. (2019) conducted an observational in Carotid artery stenosis (n=259). Deep white matter hyperintensity (DWMH) vs. Absence of DWMH was evaluated on Symptomatic carotid artery stenosis (SCAS) (OR 3.46, 95% CI 1.842-6.682, p=<0.001). Deep white matter hyperintensity (OR 3.46), absent plaque calcification, susceptibility vessel sign, and increased cerebral blood volume were associated with symptomatic carotid artery stenosis.

synapsesocial.com/papers/6a96e44f65cd0d1d26bb7c41 https://doi.org/10.3389/fneur.2019.00765

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July 16, 2019Frontiers in NeurologyOpen Access

Identification of High Risk Carotid Artery Stenosis: A Multimodal Vascular and Perfusion Imaging Study

View Full Paper

Ask AI

Bookmark

Key result

Deep white matter hyperintensity (OR 3.46), absent plaque calcification, susceptibility vessel sign, and increased cerebral blood volume were associated with symptomatic carotid artery stenosis.

Why the study?

Risk stratification of asymptomatic carotid artery stenosis remains an issue for carotid revascularization.

Population

259 patients with carotid artery stenosis who underwent carotid revascularization

Comparison

Asymptomatic vs symptomatic carotid artery stenosis

Design

Retrospective propensity score-matched study

Authors

MPMoo‐Seok Park SKSoonwook Kwon MLMi Ji Lee

Discussion

Member takes

Overview

These markers may aid symptomatic carotid stenosis identification; hypothesis-generating and requires prospective validation before practice change.

Study Design

Type

Observational (n=259)

Multicenter

Structured PICO

Population

259 patients (mean age 69 years, 15% female) with carotid artery stenosis who underwent revascularization procedures, retrospectively analyzed to identify imaging markers of symptomatic status.

Exposure

Multimodal imaging assessment including duplex sonography, computed tomography angiography, brain MRI, MRA, and perfusion-weighted imaging to identify high-risk plaque and perfusion characteristics.

Comparator

Comparison between asymptomatic carotid artery stenosis (ACAS) and symptomatic carotid artery stenosis (SCAS) patients, matched 1:1 using propensity scores.

Outcome

Factors independently associated with symptomatic carotid artery stenosis (SCAS), defined as a cerebral ischemic stroke event during the 6 months before revascularization.surrogate

Main Result

Odds Ratio: 3.46 (95% CI 1.842–6.682)

p-value: p=<0.001

Limitations

Retrospective design without imaging prior to patients becoming symptomatic
Imaging obtained during or after the acute ischemic period in the symptomatic group
Only included patients who underwent revascularization, introducing potential selection bias
Potential unmeasured confounding factors despite propensity score matching
Retrospective design
No imaging prior to becoming symptomatic (imaging obtained during or after acute ischemic period)
Selection bias (only included patients who underwent revascularization rather than best medical treatment)
Potential unmeasured confounding factors despite propensity matching
Lack of long-term follow-up

Cite This Study

synapsesocial.com/papers/6a96e44f65cd0d1d26bb7c41 https://doi.org/10.3389/fneur.2019.00765

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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