Non-stenosing carotid artery plaques in embolic stroke of undetermined source: a retrospective analysis

Authors

Ammar Jum'ah, Henry Ford HealthFollow
Hassan Aboul Nour
Osama Intikhab, Henry Ford Health
Omar Choudhury, Henry Ford HealthFollow
Karam Gagi
Michael Fana, Henry Ford HealthFollow
Hisham Alhajala
Mohammad Alkhoujah, Henry Ford HealthFollow
Owais Alsrouji, Henry Ford HealthFollow
Lara Eltous
Lonni Schultz, Henry Ford HealthFollow
Katie Latack, Henry Ford HealthFollow
Megan Brady, Henry Ford HealthFollow
Alex B. Chebl, Henry Ford HealthFollow
Horia Marin, Henry Ford HealthFollow
Daniel J. Miller, Henry Ford HealthFollow

Recommended Citation

Jumah A, Aboul Nour H, Intikhab O, Choudhury O, Gagi K, Fana M, Alhajala H, Alkhoujah M, Alsrouji OK, Eltous L, Schultz L, Latack K, Brady M, Chebl A, Marin H, and Miller D. Non-stenosing carotid artery plaques in embolic stroke of undetermined source: a retrospective analysis. Neurol Sci 2022.

Document Type

Article

Publication Date

9-27-2022

Publication Title

Neurological sciences

Abstract

BACKGROUND: We aim to identify the association between high-risk carotid plaques and their laterality to stroke in ESUS patient population. We also discuss recurrent stroke events and their laterality to the index stroke.

METHODS: This was a retrospective study. We reviewed data for patients with ESUS between June 20, 2016, and June 20, 2021. Using computed tomography angiography, we analyzed plaque features that are associated with ESUS, and then, we identified the recurrent stroke events and characterized lateralization to the index stroke.

RESULTS: Out of 1779 patients with cryptogenic ischemic stroke, we included 152 patients who met the criteria for ESUS. High-risk plaque features were found more often ipsilateral to the stroke side when compared contralaterally: plaque ulceration (19.08% vs 5.26%, p < .0001), plaque thickness > 3 mm (19.08% vs 7.24%, p = 0.001), and plaque length > 1 cm (13.16% vs 5.92%, p = 0.0218). There was also a significant difference in plaque component in which both components (soft and calcified) and only soft plaques were more prevalent ipsilaterally (42.76% vs 23.68% and 17.76% vs 9.21%, respectively, p < .0001). Of the 152 patients, 17 patients were found to have a recurrent stroke event, and 47% (n = 8) had an ipsilateral stroke to the index event. Moreover, stroke was bilateral in 41% of the patients (n = 7), and contralateral in 12% (n = 2).

CONCLUSION: High-risk plaque features studied here were more prevalent ipsilaterally to the stroke side in ESUS than contralaterally. Multicenter studies are needed to form precise prediction models and scoring systems to help guide treatment, i.e., choice of medical therapy and/or revascularization.

PubMed ID

36166175

ePublication

ePub ahead of print