Abstract: Background and Purpose: The association between nonstenotic plaque at the petrous internal carotid artery (ICA) and embolic stroke of undetermined source (ESUS) remains unknown. We aimed to test the hypothesis that the presence of a larger build-up of petrous plaque is more prevalent in the ipsilateral versus the contralateral side among ESUS patients without plaque in the intracranial and proximal ICA.
Methods: From a total of 243 patients with ESUS and 160 patients with small-vessel disease (SVD) without proximal ICA plaque, we enrolled 88 ESUS and 103 SVD patients without ipsilateral nonstenotic intracranial and proximal ICA plaque in the present study. Targeting the petrous segment of the ICA on two sides, plaque burden including plaque thickness, lumen area, vessel area, wall area, and percentage of luminal stenosis, and composition features (presence/absence of the ruptured fibrous cap, ulcer plaque, thrombus, discontinuity of plaque surface [DPS], intraplaque hemorrhage and complicated plaque) were assessed by high-resolution magnetic resonance imaging.
Results: We found a higher prevalence of petrous plaque thickness ≥3.5 mm ipsilateral versus contralateral to the stroke (25/88 [28.4%] vs. 12/88 [13.6%], odds ratio [OR] 3.60, 95% confidence interval [CI] 1.34-9.70), but this imbalance was not seen in SVD. In patients with plaque thickness ≥3.5 mm, the presence of DPS (OR 4.05, 95% CI 1.11-14.78) and complicated plaque (OR 5.00, 95% CI 1.10-22.82) was more closely related to an index ESUS, a finding that was not evident in the subgroup with petrous plaque <3.5 mm (p for interaction = 0.027).
Conclusions: The present study provided the first evidence supporting a potential etiological role of vulnerable petrous plaque in ESUS.
(© 2022 European Academy of Neurology.)
References: Hart RG, Diener HC, Coutts SB, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014;13:429-438.
Ntaios G, Swaminathan B, Berkowitz SD, et al. Efficacy and safety of rivaroxaban versus aspirin in embolic stroke of undetermined source and carotid atherosclerosis. Stroke. 2019;50:2477-2485.
Ntaios G, Pearce LA, Meseguer E, et al. Aortic arch atherosclerosis in patients with embolic stroke of undetermined source: an exploratory analysis of the NAVIGATE ESUS trial. Stroke. 2019;50:3184-3190.
Ntaios G, Wintermark M, Michel P. Supracardiac atherosclerosis in embolic stroke of undetermined source: the underestimated source. Eur Heart J. 2020;16:ehaa218.
Komatsu T, Iguchi Y, Arai A, et al. Large but nonstenotic carotid artery plaque in patients with a history of embolic stroke of undetermined source. Stroke. 2018;49:3054-3056.
Buon R, Guidolin B, Jaffre A, et al. Carotid ultrasound for assessment of nonobstructive carotid atherosclerosis in young adults with cryptogenic stroke. J Stroke Cerebrovasc Dis. 2018;27:1212-1216.
Coutinho JM, Derkatch S, Potvin AR, et al. Nonstenotic carotid plaque on CT angiography in patients with cryptogenic stroke. Neurology. 2016;87:665-672.
Ospel JM, Singh N, Marko M, et al. Prevalence of ipsilateral nonstenotic carotid plaques on computed tomography angiography in embolic stroke of undetermined source. Stroke. 2020;51:1743-1749.
Siegler JE, Thon JM, Woo JH, Do D, Messé SR, Cucchiara B. Prevalence of nonstenotic carotid plaque in stroke due to atrial fibrillation compared to embolic stroke of undetermined source. J Stroke Cerebrovasc Dis. 2019;28:104289.
Kopczak A, Schindler A, Bayer-Karpinska A, et al. Complicated carotid artery plaques as a cause of cryptogenic stroke. J Am Coll Cardiol. 2020;76:2212-2222.
Freilinger TM, Schindler A, Schmidt C, et al. Prevalence of nonstenosing, complicated atherosclerotic plaques in cryptogenic stroke. JACC Cardiovasc Imaging. 2012;5:397-405.
Gupta A, Gialdini G, Lerario MP, et al. Magnetic resonance angiography detection of abnormal carotid artery plaque in patients with cryptogenic stroke. J Am Heart Assoc. 2015;4:e002012.
Ritz K, Denswil NP, Stam OC, van Lieshout JJ, Daemen MJ. Cause and mechanisms of intracranial atherosclerosis. Circulation. 2014;130:1407-1414.
Portanova A, Hakakian N, Mikulis DJ, Virmani R, Abdalla WM, Wasserman BA. Intracranial vasa vasorum: insights and implications for imaging. Radiology. 2013;267:667-679.
Chen X, Zhao H, Chen Z, et al. Association between proximal internal carotid artery steno-occlusive disease and diffuse wall thickening in its petrous segment: a magnetic resonance vessel wall imaging study. Neuroradiology. 2017;59:485-490.
Tao L, Li XQ, Hou XW, et al. Intracranial atherosclerotic plaque as a potential cause of embolic stroke of undetermined source. J Am Coll Cardiol. 2021;77:680-691.
Swartz RH, Bhuta SS, Farb RI, et al. Intracranial arterial wall imaging using high-resolution 3-tesla contrast-enhanced MRI. Neurology. 2009;72:627-634.
Barnett HJ, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis: North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1998;339:1415-1425.
Cai JM, Hatsukami TS, Ferguson MS, Small R, Polissar NL, Yuan C. Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging. Circulation. 2002;106:1368-1373.
Varnava AM, Mills PG, Davies MJ. Relationship between coronary artery remodeling and plaque vulnerability. Circulation. 2002;105:939-943.
Schoenhagen P, Ziada KM, Vince DG, Nissen SE, Tuzcu EM. Arterial remodeling and coronary artery disease: the concept of "dilated" versus "obstructive" coronary atherosclerosis. J Am Coll Cardiol. 2001;38:297-306.
Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med. 1987;316:1371-1375.
Perera KS, Ng KKH, Nayar S, et al. Association between low-dose rivaroxaban with or without aspirin and ischemic stroke subtypes: a secondary analysis of the COMPASS trial. JAMA Neurol. 2020;77:43-48.
Mandell DM, Mossa-Basha M, Qiao Y, et al. Intracranial vessel wall MRI: principles and expert consensus recommendations of the American Society of Neuroradiology. Am J Neuroradiol. 2017;38:218-229.
Kerwin WS, Hatsukami T, Yuan C, Zhao XQ. MRI of carotid atherosclerosis. AJR Am J Roentgenol. 2013;200:W304-W313.
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