Carotid artery plaques in stroke patients up the risk for recurrent ischemic stroke or TIA: JACC
Germany: Stroke patients with complicated carotid artery plaques (CAPs) are at a higher risk of recurrent ischemic stroke or transient ischemic attack (TIA) compared to those without, finds a recent study in the Journal of the American College of Cardiology (JACC). In patients with a cryptogenic stroke etiology, this risk was accentuated.
Imaging of carotid plaque may help in identifying high-risk patients who might be eligible for inclusion in future prevention trials. However, enthusiasm for such trials may be reduced by the need for a contrasted MRI to diagnose the most complicated carotid plaques, resulting in considerable expense and decreased generalizability.
Complicated carotid plaques are those with an intraplaque hemorrhage, ruptured fibrous cap, or associated mural thrombus. Complicated nonstenosing carotid artery plaques are an under-recognized cause of stroke. Anna Kopczak, Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany, and colleagues aimed to determine whether complicated CAP ipsilateral to acute ischemic anterior circulation stroke (icCAP) are associated with recurrent ischemic stroke or transient ischemic attack in a prospective cohort study.
For this purpose, the researchers recruited patients restricted to the territory of a single carotid artery in their CAPIAS (Carotid Plaque Imaging in Acute Stroke) multicenter study. Complicated (AHA-lesion type VI) CAP was defined by multisequence, contrast-enhanced carotid magnetic resonance imaging obtained within 10 days from stroke onset.
Assessment of recurrent events was done after 3, 12, 24, and 36 months. Recurrent ischemic stroke or TIA was the primary outcome.
Based on the study, the researchers reported the following findings:
- Among 196 patients enrolled, 104 patients had a cryptogenic stroke and nonstenosing CAP.
- During a mean follow-up of 30 months, recurrent ischemic stroke or TIA occurred in 21 patients.
- Recurrent events were significantly more frequent in patients with icCAP than in patients without icCAP, both in the overall cohort (incidence rate [3-year interval]: 9.50 vs 3.61 per 100 patient-years) and in patients with cryptogenic stroke (10.92 vs 1.82 per 100 patient-years).
- The results were driven by ipsilateral events. A ruptured fibrous cap (HR: 4.91) and intraplaque hemorrhage (HR: 4.37) were associated with a significantly increased risk of recurrent events in patients with cryptogenic stroke.
The researchers conclude, "cCAP ipsilateral to acute ischemic anterior circulation stroke is associated with a substantially increased risk of recurrent ischemic stroke or TIA."
"Carotid plaque imaging identifies high-risk patients who might be suited to be included in future secondary prevention trials."
Reference:
Complicated Carotid Artery Plaques and Risk of Recurrent Ischemic Stroke or TIA. J Am Coll Cardiol 2022;79:2189-2199.
