Presenter of 1 Presentation
CAROTID PLAQUE CHARACTERISTICS PREDICT RECURRENT ISCHEMIC STROKE: THE PLAQUE AT RISK (PARISK) STUDY
Abstract
Background and Aims
Patients with symptomatic carotid stenosis are at high risk for recurrent stroke. Currently, treatment decisions for carotid revascularization mainly rely on degree of stenosis. However, other plaque characteristics might be better determinants of recurrent stroke, allowing more targeted intervention. The Plaque At RISK (PARISK)-study aimed to improve identification of patients at increased risk of recurrent stroke using multimodality carotid imaging.
Methods
We included 240 patients with symptomatic <70% ipsilateral carotid stenosis in a prospective multicenter cohort study. MRI (carotid and brain) and MDCTA (carotid) were performed at baseline and after 2 years. The clinical endpoint was a recurrent ipsilateral ischemic stroke or TIA. Cox-proportional hazard models were used to assess whether intraplaque hemorrhage (IPH), ulceration, proportion of calcifications, and total plaque volume in ipsilateral carotid plaques were associated with the endpoint. Next, we investigated the predictive performance of these imaging biomarkers by adding (combinations of) these markers to the ECST-risk score.
Results
During 5.1 years follow-up 37 patients reached the clinical endpoint. IPH presence and total plaque volume were associated with recurrent ipsilateral ischemic stroke or TIA (HR=2.12, 95%CI: 1.02-4.44 for IPH; HR=1.07, 95%CI: 1.00-1.15 for total plaque volume per 100 mm3 increase). Ulcerations and proportion of calcifications were not statistically significant determinants. Addition of IPH and total plaque volume to the ECST-risk score improved the model performance (C-statistics increased from 0.67 to 0.75-0.78).
Conclusions
IPH and total plaque volume are independent risk factors of recurrent ipsilateral ischemic stroke or TIA in patients with mild-to-moderate carotid stenosis. These plaque characteristics improve current decision making.