CAROTID PLAQUE INFLAMMATION IMAGED BY POSITRON EMISSION TOMOGRAPHY IMPROVES PREDICTION OF LATE RECURRENT STROKE AT 5 YEARS. (ID 900)

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AS20 LARGE ARTERY ATHEROSCLEROSIS - INCLUDING INTRACRANIAL STENOSIS
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Topic: CAROTID PLAQUE INFLAMMATION IMAGED BY POSITRON EMISSION TOMOGRAPHY IMPROVES PREDICTION OF LATE RECURRENT STROKE AT 5 YEARS. (ID 900) Time: Sep 2, 2021 10:00 AM Dublin Join Zoom Meeting https://zoom.us/j/97206821023?pwd=V0M4RHlrcSs1cmk4dVlWYy9zR2pNUT09 Meeting ID: 972 0682 1023 Passcode: K7n8dM
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Abstract

Background And Aims

18F-fluorodeoxyglucose positron emission tomography (18FDG-PET) identifies carotid plaque inflammation and predicts early recurrent stroke. No data exists on carotid plaque inflammation measured by 18FDG-PET and late recurrent stroke.

Methods

We did an individual-participant data pooled analysis of three prospective studies with near-identical study methods. Eligible patients had recent non-severe (modified Rankin Score ≤3) ischaemic stroke/transient ischemic attack and ipsilateral carotid stenosis (50-99%). Participants underwent carotid 18FDG-PET/CT angiography ≤14 days after recruitment. 18FDG uptake was expressed as maximum standardized uptake value (SUVmax) in the axial single hottest slice of symptomatic plaque. We calculated the previously-validated Symptomatic Carotid Atheroma Inflammation Lumen-stenosis (SCAIL) score, incorporating a measure of stenosis severity and 18FDG-uptake. The primary outcome was 5-year recurrent ipsilateral ischaemic stroke after PET.

Results

Of 183 eligible patients, 181 patients completed follow-up (98.9%). The median duration of follow-up was 4.9 years (interquartile range 3.3-6.4, cumulative follow-up 901.8 patient-years). After PET imaging, there were 17 recurrent ipsilateral ischemic strokes at 5 years (recurrence rate 9.4%, 95% CI 5.6-14.6%). Baseline plaque SUVmax independently predicted 5-year ipsilateral recurrent stroke after adjustment for age, gender, carotid revascularization, stenosis severity, NIHSS, and diabetes mellitus (adjusted HR 1.98; 95 % CI, 1.10-3.56, p=0.02, per 1g/mL increase SUVmax). On multivariable Cox regression, SCAIL score predicted 5-year ipsilateral stroke (adjusted HR 2.73 per 1-point increase; 95% CI 1.52-4.90, p=0.001).

Conclusions

Plaque inflammation-related 18FDG-uptake improved identification of 5-year recurrent ipsilateral ischaemic stroke. Addition of plaque inflammation to current selection strategies may target patients most likely to have benefit from carotid revascularization.

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Not applicable

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