Non-stenosing carotid artery plaques in embolic stroke of undetermined source: a retrospective analysis

Jumah, Ammar; Nour, Hassan Aboul; Intikhab, Osama; Choudhury, Omar; Gagi, Karam; Fana, Michael; Alhajala, Hisham; Alkhoujah, Mohammad; Alsrouji, Owais; Eltous, Lara; Schultz, Lonni; Latack, Katie; Brady, Megan; Chebl, Alex; Marin, Horia; Miller, Daniel J.

doi:10.1007/s10072-022-06425-w

Cited by 5 publications

(2 citation statements)

References 20 publications

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“…In contrast, a recent retrospective study of 152 patients with ESUS by Jumah et al 25 found that plaque ulceration as seen on CTA was more prevalent in ipsilateral carotid arteries versus contralateral ones. In addition, plaque thickness (.3mm), plaque length (.1 cm), and hypodense plaque were significantly associated with ipsilateral stroke, whereas calcification was not.…”

Section: Ctamentioning

confidence: 83%

“…Although certain CT features of carotid plaques such as surface irregularity, ulceration, hypodensity, and calcification are thought to represent features of vulnerable plaque, their association with ipsilateral stroke in patients with ESUS remains unclear in the context of conflicting reports (Fig 3). 10,23,25,26 Given the high clinical utility of CT and CTA in the acute stroke setting, continued exploration of the potential association between these features and ischemic events in patients with ESUS is likely worthwhile to clarify these discrepancies.…”

Section: Ctamentioning

confidence: 99%

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Nonstenotic Carotid Plaques and Embolic Stroke of Undetermined Source: A Multimodality Review

Larson¹,

Brinjikji²,

Lekah³

et al. 2022

AJNR Am J Neuroradiol

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Symptomatic nonstenotic carotid artery disease has been increasingly recognized as a thromboembolic source in patients who would otherwise be classified as having embolic stroke of undetermined source. Evidence suggests that certain plaque features seen on sonography, CT, and MR imaging in nonstenotic carotid artery disease may predispose to recurrent stroke in patients with embolic stroke of undetermined source. We performed a focused literature review to further study plaque features in the context of embolic stroke of undetermined source and to determine which plaque features may be associated with ipsilateral ischemic events in such patients. Plaque thickness as seen on both ultrasound and CT appears to have a consistent association with ipsilateral stroke in patients with embolic stroke of undetermined source across multiple studies. Intraplaque hemorrhage as seen on MR imaging is now understood to have a strong association with ipsilateral stroke in patients with embolic stroke of undetermined source. Continued study of various plaque features as seen on different modalities is warranted to uncover other potential associations.ABBREVIATIONS: ESUS ¼ embolic stroke of undetermined source; IPH ¼ intraplaque hemorrhage; LRNC ¼ lipid-rich necrotic core; SyNC ¼ symptomatic nonstenotic carotid artery disease; US ¼ ultrasound U p to one-third of strokes have no established mechanism and are considered to be cryptogenic. 1 In 2014, the term "embolic stroke of undetermined source" (ESUS) was established as a clinical entity in patients with nonlacunar cryptogenic stroke in which an embolic source was thought to be most likely, despite an appropriate diagnostic evaluation with negative findings (Fig 1). 2 This term (along with "cryptogenic stroke") has also been used to define patients who may have multiple, competing stroke etiologies in which a definitive source cannot be determined. Patients with ESUS have been estimated to have a .4% risk of recurrent stroke per annum despite being on antiplatelet medication. 1 Subsequent thought was directed to the idea that anticoagulation may be beneficial in such patients, given the likelihood that emboli originated from various nonevident atheroembolic sources. 3 This premise provided the impetus for 2 large clinical trials that compared anticoagulation with aspirin alone in patients with ESUS. 4,5 Despite this plausible theory, no benefit of anticoagulation was observed. These results spurred continued interest in additional

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Section: Ctamentioning

confidence: 83%

Section: Ctamentioning

confidence: 99%

Nonstenotic Carotid Plaques and Embolic Stroke of Undetermined Source: A Multimodality Review

Larson¹,

Brinjikji²,

Lekah³

et al. 2022

AJNR Am J Neuroradiol

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Neurosonographie an der Stroke Unit – ein Update

Haidegger,

Kneihsl

2024

psychopraxis. neuropraxis

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ZusammenfassungDer Einsatz der Neurosonographie ist ein wesentlicher Bestandteil der Routineabklärung nach ischämischem Schlaganfall. Als einfach anzuwendende Bedside-Untersuchung kann diese direkt in der Akutaufnahme/an der Stroke Unit durchgeführt werden, wobei drei Domänen zu nennen sind: 1) Okklusionsprozesse der hirnversorgenden Gefäße: Abgesehen von der Detektion hochgradiger Stenosen und von Verschlüssen eignet sich der Ultraschall hervorragend dazu, die Oberfläche und Echogenität atherosklerotischer Plaques der hirnversorgenden Gefäße zu beurteilen. So können Risikoplaques identifiziert werden, die unabhängig vom Stenosegrad mit dem Auftreten von Schlaganfällen assoziiert sind. 2) Zerebrale Hämodynamik nach Gefäßrekanalisation: Die mechanische Thrombektomie hat das Ergebnis von Schlaganfallpatient:innen mit Großgefäßverschluss maßgeblich verbessert. Etwa ein Drittel dieser Patient:innen weist Störungen der zerebralen Hämodynamik auf. Beispielhaft sei das Hyperperfusionssyndrom zu nennen, das mit einem erhöhten Risiko für Infarkteinblutungen verbunden ist. Der Einsatz des transkraniellen Ultraschalls ermöglicht es, derartige Veränderungen frühzeitig zu erkennen und im Rahmen einer individualisierten Behandlung zu berücksichtigen. 3) Rechts-Links-Shunt-Diagnostik: Bei Patient:innen unter 60 Jahren mit kortikalen Infarkten und unauffälliger Routineabklärung sollte nach einem Rechts-Links-Shunt in Form eines persistierenden Foramen ovale gesucht werden. Der transkranielle Ultraschall eignet sich durch seine hohe Sensitivität als hervorragendes Screening-Instrument zur Diagnostik des Rechts-Links-Shunts.

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Novel Targets for Molecular Imaging of Inflammatory Processes of Carotid Atherosclerosis: A Systematic Review

Maes,

Versweyveld,

Evans

et al. 2024

Seminars in Nuclear Medicine

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Non-stenosing carotid artery plaques in embolic stroke of undetermined source: a retrospective analysis

Cited by 5 publications

References 20 publications

Nonstenotic Carotid Plaques and Embolic Stroke of Undetermined Source: A Multimodality Review

Nonstenotic Carotid Plaques and Embolic Stroke of Undetermined Source: A Multimodality Review

Neurosonographie an der Stroke Unit – ein Update

Novel Targets for Molecular Imaging of Inflammatory Processes of Carotid Atherosclerosis: A Systematic Review

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