Management of carotid atherosclerosis in stroke

Evans, Nicholas Richard; Bhakta, Shiv; Chowdhury, Mohammed M; Markus, Hugh; Warburton, Elizabeth

doi:10.1136/pn-2023-003918

Cited by 2 publications

(1 citation statement)

References 48 publications

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“…Some authors propose it as a regulated process based on histological resemblance to trabecular bone. Histological studies demonstrated mild calcifications are associated with soft plaque and medium-to-severe calcifications are associated with hard plaques [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Cone-Beam Computed Tomography Scans to Develop a Staging Method of External Carotid Artery Calcification

Kadyan,

Vaddi,

Nagpal

et al. 2024

JCM

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Background: The objective of this study was to develop a practical staging method for reporting external carotid artery calcifications (ECACs) using cone-beam computed tomography (CBCT) imaging, specifically to standardize reporting for oral and maxillofacial radiologists. Methods: This retrospective study evaluated 489 CBCT scans for the presence of ECACs. Two calibrated evaluators assessed the scans in all three orthogonal planes, using the axial plane to develop the staging system. Calcifications were graded on a scale from 0 to 5. Results: ECACs were found in 170 out of 489 scans (34.7%). There was a statistically significant increase in ECAC distribution with age progression. The prevalence of ECACs was similar between genders. Grade 1 calcifications were most common in the 51–60 age group, Grade 2 in the 61–70 and 71–80 groups, and Grades 3 and 4 in the 81–90 group. No Grade 5 calcifications were observed in any age group. The inter-rater reliability showed an excellent correlation in the identification and grading of ECACs. Conclusions: The proposed grading system enables oral and maxillofacial radiologists to quantitatively report ECACs, facilitating timely referrals to physicians for further evaluation and early intervention, thereby potentially reducing the risk of cardiovascular events

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Section: Discussionmentioning

confidence: 99%

Evaluation of Cone-Beam Computed Tomography Scans to Develop a Staging Method of External Carotid Artery Calcification

Kadyan,

Vaddi,

Nagpal

et al. 2024

JCM

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Carotid atherosclerotic plaque microcalcification is independently associated with recurrent neurovascular events: A pilot study

Bhakta,

Tarkin,

Chowdhury

et al. 2024

International Journal of Stroke

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Background Microcalcification and macrocalcification are critical processes in atherosclerotic plaque progression, though how these processes relate to the risk of stroke recurrence in symptomatic carotid atherosclerosis is poorly understood. Methods We performed a post-hoc analysis of data from the ICARUSS study, where individuals with acute ischemic stroke originating from ipsilateral carotid stenosis of ≥50% underwent 18F-sodium fluoride-positron emission tomography (NaF-PET) to measure microcalcification. Tracer uptake was quantified using maximum tissue-to-background ratio (TBRmax). Macrocalcification was measured on computed tomography (CT) using Agatston scoring. Patients were followed up for six months for recurrent ipsilateral neurovascular events. Results Five (27.8%) of 18 individuals had a recurrent ischemic stroke or transient ischemic attack. Ipsilateral carotid plaque NaF uptake at baseline was higher in those with recurrent events compared to those without, and this association remained after adjustment for other vascular risk factors (OR 1.24, 1.03-1.50). Macrocalcification score in the symptomatic artery was also significantly independently associated with ipsilateral recurrence, but the effect size was relatively smaller (OR 1.12, 1.06-1.17 for each 100 unit increase). Conclusions Our findings indicate that microcalcification in symptomatic carotid plaques is independently associated with ipsilateral ischemic stroke recurrence. Furthermore, differences in the extent of active microcalcification in macrocalcified plaques may help explain variation in the relationship between calcified carotid plaques and stroke recurrence reported in the literature. Our pilot study indicates that evaluation of carotid artery microcalcification using NaF-PET may be a useful method for risk-stratification of carotid atherosclerosis, though our findings require confirmation in larger cohorts.

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Management of carotid atherosclerosis in stroke

Cited by 2 publications

References 48 publications

Evaluation of Cone-Beam Computed Tomography Scans to Develop a Staging Method of External Carotid Artery Calcification

Evaluation of Cone-Beam Computed Tomography Scans to Develop a Staging Method of External Carotid Artery Calcification

Carotid atherosclerotic plaque microcalcification is independently associated with recurrent neurovascular events: A pilot study

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