Intraplaque hemorrhage in carotid stenosis doubles risk of recurrent stroke or TIA: Study
Netherlands: In patients with mild-to-moderate carotid stenosis, carotid intraplaque hemorrhage (IPH) and total plaque volume increase the risk of transient ischemic attack or recurrent ipsilateral ischemic stroke, says a study published in JACC: Cardiovascular Imaging. These plaque characteristics boost current decision-making.the
Symptomatic carotid stenosis patients are at high recurrent stroke risk. Currently, the decision for carotid endarterectomy mainly relies on the degree of stenosis (cutoff value >50% or 70%). Mild-to-moderate stenosis patients still have a considerable risk of recurrent stroke. Increasing evidence has indicated that plaque vulnerability is determined by carotid plaque composition rather than the degree of stenosis. However, it is unclear whether this also provides additional information for improving clinical decision-making.
Against the above background, Dianne H.K.van Dam-Nolen, Department of Neurology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands, and colleagues conducted the PARISK (Plaque At RISK) study to improve the identification of patients who are at increased recurrent ischemic stroke risk using multimodality carotid imaging.
A total of 244 patients with recent symptomatic mild-to-moderate carotid stenosis were included in a prospective multicenter cohort study. At baseline and after two years, magnetic resonance imaging (brain and carotid) and computed tomography angiography (carotid) were performed. The clinical endpoint was a transient ischemic attack (TIA) or a recurrent ipsilateral ischemic stroke.
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