Prediction of Stroke Risk by Detection of Hemorrhage in Carotid Plaques Meta-Analysis of Individual Patient Data

Andreas Schindler, Regina Schinner, Nishaf Altaf, Akram A. Hosseini, Richard J. Simpson, Lorena Esposito-Bauer, Navneet Singh, Robert M. Kwee, Yoshitaka Kurosaki, Sen Yamagata, Kazumichi Yoshida, Susumu Miyamoto, Robert Maggisano, Alan R. Moody, Holger Poppert, M. Eline Kooi, Dorothee P. Auer, Leo H. Bonati*, Tobias Saam

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

81 Citations (Web of Science)

Abstract

OBJECTIVES The goal of this study was to compare the risk of stroke between patients with carotid artery disease with and without the presence of intraplaque hemorrhage (IPH) on magnetic resonance imaging.

BACKGROUND IPH in carotid stenosis increases the risk of cerebrovascular events. Uncertainty remains whether risk of stroke alone is increased and whether stroke is predicted independently of known risk factors.

METHODS Data were pooled from 7 cohort studies including 560 patients with symptomatic carotid stenosis and 136 patients with asymptomatic carotid stenosis. Hazards of ipsilateral ischemic stroke (primary outcome) were compared between patients with and without IPH, adjusted for clinical risk factors.

RESULTS IPH was present in 51.6% of patients with symptomatic carotid stenosis and 29.4% of patients with asymptomatic carotid stenosis. During 1,121 observed person-years, 66 ipsilateral strokes occurred. Presence of IPH at baseline increased the risk of ipsilateral stroke both in symptomatic (hazard ratio [HR]: 10.2; 95% confidence interval [CI]: 4.6 to 22.5) and asymptomatic (HR: 7.9; 95% CI: 1.3 to 47.6) patients. Among patients with symptomatic carotid stenosis, annualized event rates of ipsilateral stroke in those with IPH versus those without IPH were 9.0% versus 0.7% (

CONCLUSIONS IPH is common in patients with symptomatic and asymptomatic carotid stenosis and is a stronger predictor of stroke than any known clinical risk factors. Magnetic resonance imaging might help identify patients with carotid disease who would benefit from revascularization. (C) 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

Original languageEnglish
Pages (from-to)395-406
Number of pages12
JournalJACC-Cardiovascular Imaging
Volume13
Issue number2
DOIs
Publication statusPublished - Feb 2020

Keywords

  • carotid
  • cerebrovascular event
  • intraplaque hemorrhage
  • ischemic stroke
  • magnetic resonance imaging
  • NASCET
  • TRANSIENT ISCHEMIC ATTACK
  • INTRAPLAQUE HEMORRHAGE
  • ARTERY STENOSIS
  • ENDARTERECTOMY
  • POPULATION
  • MODERATE
  • ATHEROSCLEROSIS
  • ASSOCIATION
  • RECURRENCE
  • DISEASE

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