Contemporary prevalence of carotid stenosis in patients presenting with ischaemic stroke

Cheng, Suk Fun; Brown, Martin M.; Simister, Robert; Richards, Toby

doi:10.1002/bjs.11136

Cited by 46 publications

(28 citation statements)

References 25 publications

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“…Carotid stenosis as the underlying etiology is found in up to 20% of cerebrovascular ischemic events. 1,2 Current American Heart Association/American Stroke Association guidelines recommend carotid revascularization only in patients with symptomatic carotid stenosis of .50%. 3 This recommendation is supported by data from the European Carotid Surgery Trial (ECST) and North America Symptomatic Carotid Endarterectomy Trial (NASCET), which showed a significant reduction of future strokes after revascularization of symptomatic severe carotid stenoses but modest benefit in moderate stenoses.…”

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confidence: 99%

The Risk of Stroke and TIA in Nonstenotic Carotid Plaques: A Systematic Review and Meta-Analysis

Singh

Marko

Ospel

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND: Severe carotid stenosis carries a high risk of stroke. However, the risk of stroke with nonstenotic carotid plaques (,50%) is increasingly recognized. PURPOSE:We aimed to summarize the risk of TIA or stroke in patients with nonstenotic carotid plaques. DATA SOURCES:We performed a comprehensive systematic review and meta-analysis in patients with acute ischemic stroke in whom carotid imaging was performed using MEDLINE and the Cochrane Database, including studies published up to December 2019.STUDY SELECTION: Included studies had .10 patients with ,50% carotid plaques on any imaging technique and reported the incidence or recurrence of ischemic stroke/TIA. High-risk plaque features and the risk of progression to stenosis .50% were extracted if reported. DATA SYNTHESIS:We identified 31 studies reporting on the risk of ipsilateral stroke/TIA in patients with nonstenotic carotid plaques. Twenty-five studies (n ¼ 13,428 participants) reported on first-ever stroke/TIA and 6 studies (n ¼ 122 participants) reported on the recurrence of stroke/TIA. DATA ANALYSIS:The incidence of first-ever ipsilateral stroke/TIA was 0.5/100 person-years. The risk of recurrent stroke/TIA was 2.6/100 person-years and increased to 4.9/100 person-years if intraplaque hemorrhage was present. The risk of progression to severe stenosis (.50%) was 2.9/100 person-years (8 studies, n ¼ 448 participants). LIMITATIONS:Included studies showed heterogeneity in reporting stroke etiology, the extent of stroke work-up, imaging modalities, and classification systems used for characterizing carotid stenosis. CONCLUSIONS:The risk of recurrent stroke/TIA in nonstenotic carotid plaques is not negligible, especially in the presence of highrisk plaque features. Further research is needed to better define the significance of nonstenotic carotid plaques for stroke etiology.

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confidence: 99%

The Risk of Stroke and TIA in Nonstenotic Carotid Plaques: A Systematic Review and Meta-Analysis

Singh

Marko

Ospel

et al. 2020

AJNR Am J Neuroradiol

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“…Similar to data found by other researchers, we observed that patients with significant carotid stenosis were more likely to have hypertension, hypercholesterolaemia, diabetes and ischaemic heart disease. (2,3) Those pathological associations with synergic effect on the development of atherosclerosis on large vessels results in current strategies of curative treatment and secondary prevention of ischemic stroke. (4,5) For the secondary prevention of ischemic stroke, the last guide of Romanian Society of Neurology (after ESO GUIDE 2008) specifies (recommendations Class I Level A):  It is recommended for patients to receive antithrombotic/antiplatelet therapy; …”

Section: Discussionmentioning

confidence: 99%

Carotid Atherosclerotic Disease and Risk Factors in Patients with Ischemic Stroke – Study Report –

Mutu

Cerei

2019

Acta Medica Transilvanica

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Ischemic stroke (IS) is the second frequent vascular disease after myocardial infarction, with different clinical and etiological aspects and various risk factors. Large vessel atherosclerotic disease is the most frequent IS causing pathology, followed by cerebral microangiopathy and cardioembolic events. Cervical arteries Doppler ultrasonography helps identifying the subtype of IS, and by revealing the vascular status of the patient, guides the therapeutic decision and secondary IS prevention. The aim of this paper is to present the results of an observational, retrospective, analytical study on a number of 174 patients with acute IS evaluated by Doppler carotid ultrasound in CVASIC Research Centre of Academic Emergency Hospital of Sibiu from January to December 2018. Materials and methods: All patients with IS admitted in our centre received a Doppler carotid ultrasound evaluation. We observed the degree of carotid stenosis, presence of atherosclerotic risk factors and their influence. Results: The mean age of patients was 71.3 years (36 to 92 years range). 16 (9.19%) patients presented occlusion of internal carotid artery (ICA) on the same side as stroke, 37 (21.26%) had severe carotid stenosis (>70%), 31 (17.81%) presented moderate stenosis (50-70%), the remaining patients had mild or no stenosis. 129 (74,13%) patients presented arterial hypertension, 51 (29.31%) patients had diabetes mellitus, 14 (8.04%) were smokers, 81 (46.56%) had dyslipidemia. Conclusions: A large number of patients had severe carotid stenosis and occlusion. The most common risk factor was arterial hypertension, followed by dyslipidemia and diabetes mellitus. Continuous medical education of population at risk regarding good nutrition principles and healthy lifestyle are needed to reduce the social costs of ischemic stroke.

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“…Around 15%e20% of ischaemic strokes are caused by extracranial carotid stenosis, 1 and such stenoses are also associated with an increased risk of coronary events and vascular death. 2,3 Appropriate use of triple medical therapy (i.e., lipid lowering medication, antiplatelet drugs, and blood pressure lowering agents) in patients with clinically significant asymptomatic carotid stenosis (ACS), that is, !…”

Section: Introductionmentioning

confidence: 99%

Development and Internal Validation of a Risk Score to Detect Asymptomatic Carotid Stenosis

Poorthuis

Sherliker

Morris

et al. 2021

European Journal of Vascular and Endovascular Surgery

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Objective Asymptomatic carotid stenosis (ACS) is associated with an increased risk of ischaemic stroke and myocardial infarction. Risk scores have been developed to detect individuals at high risk of ACS, thereby enabling targeted screening, but previous external validation showed scope for refinement of prediction by adding additional predictors. The aim of this study was to develop a novel risk score in a large contemporary screened population. Methods A prediction model was developed for moderate (≥50%) and severe (≥70%) ACS using data from 596 469 individuals who attended screening clinics. Variables that predicted the presence of ≥50% and ≥70% ACS independently were determined using multivariable logistic regression. Internal validation was performed using bootstrapping techniques. Discrimination was assessed using area under the receiver operating characteristic curves (AUROCs) and agreement between predicted and observed cases using calibration plots. Results Predictors of ≥50% and ≥70% ACS were age, sex, current smoking, diabetes mellitus, prior stroke/transient ischaemic attack, coronary artery disease, peripheral arterial disease, blood pressure, and blood lipids. Models discriminated between participants with and without ACS reliably, with an AUROC of 0.78 (95% confidence interval [CI] 0.77–0.78) for ≥ 50% ACS and 0.82 (95% CI 0.81–0.82) for ≥ 70% ACS. The number needed to screen in the highest decile of predicted risk to detect one case with ≥50% ACS was 13 and that of ≥70% ACS was 58. Targeted screening of the highest decile identified 41% of cases with ≥50% ACS and 51% with ≥70% ACS. Conclusion The novel risk model predicted the prevalence of ACS reliably and performed better than previous models. Targeted screening among the highest decile of predicted risk identified around 40% of all cases with ≥50% ACS. Initiation or intensification of cardiovascular risk management in detected cases might help to reduce both carotid related ischaemic strokes and myocardial infarctions.

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Contemporary prevalence of carotid stenosis in patients presenting with ischaemic stroke

Cited by 46 publications

References 25 publications

The Risk of Stroke and TIA in Nonstenotic Carotid Plaques: A Systematic Review and Meta-Analysis

The Risk of Stroke and TIA in Nonstenotic Carotid Plaques: A Systematic Review and Meta-Analysis

Carotid Atherosclerotic Disease and Risk Factors in Patients with Ischemic Stroke – Study Report –

Development and Internal Validation of a Risk Score to Detect Asymptomatic Carotid Stenosis

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