Complicated carotid artery plaques (cCAPs) are associated with an increased risk of rupture and subsequent stroke. The geometry of the carotid bifurcation determines the distribution of local ...hemodynamics and could thus contribute to the development and composition of these plaques. Therefore, we studied the role of carotid bifurcation geometry in the presence of cCAPs.
We investigated the association of individual vessel geometry with carotid artery plaque types in the Carotid Plaque Imaging in Acute Stroke (CAPIAS) study. After excluding arteries without plaque or with insufficient MRI quality, 354 carotid arteries from 182 patients were analyzed. Individual parameters of carotid geometry i.e., internal carotid artery (ICA)/common carotid artery (CCA) ratio, bifurcation angle, and tortuosity) were derived from time-of-flight MR images. The lesion types of carotid artery plaques were determined according to the American Heart Association classification of lesions by multi-contrast 3T-MRI. The association between carotid geometry and a cCAP was studied using logistic regression after adjusting for age, sex, wall area, and cardiovascular risk factors.
Low ICA/CCA ratios (OR per SD increase 0.60 95%CI: 0.42-0.85;
= 0.004) and low bifurcation angles (OR 0.61 95%CI: 0.42-0.90;
= 0.012) were significantly associated with the presence of cCAPs after adjusting for age, sex, cardiovascular risk factors, and wall area. Tortuosity had no significant association with cCAPs. Only ICA/CCA ratio remained significant in a model containing all three geometric parameters (OR per SD increase 0.65 95%CI: 0.45-0.94;
= 0.023).
A steep tapering of the ICA relative to the CCA and, to a lesser extent, a low angle of the carotid bifurcation were associated with the presence of cCAPs. Our findings highlight the contribution of bifurcation geometry to plaque vulnerability. Thus, assessment of carotid geometry could be helpful in identifying patients at risk of cCAPs.
Abstract only
Introduction:
Revacept is a novel vascular lesion-directed inhibitor of platelet adhesion and thrombus formation, exhibiting no effects on the homeostatic functions of circulating ...platelets.
Objective:
The effects of Revacept on plaque-mediated thrombosis were investigated in patients with symptomatic stenosis of the internal carotid artery (at least 50%, following ECST-criteria).
Methods:
Within an international, prospective, multicenter (n=16), randomized trial 158 patients could be randomized to receive placebo, or 40/120 mg Revacept by intravenous infusion over 20 minutes. Cerebrovascular events and cardiovascular complications were followed up to 3 months.
Results:
158 patients were finally included in the study. Of these, 127 (80.4%) received carotid endarterectomy, 12 received carotid stenting (7.6%) and 19 were referred to intensified conservative treatment (12.0%). Safety data showed cardiovascular events such as transitory ischemic attack (TIA) and ischemic stroke 24 hours after drug administration in 1 (0.6%) and 5 (3.1%) patients, and 3 months after drug administration in 5 (3.1%) and 9 (5.7%) patients, respectively. With regard to bleeding complications, intracerebral hemorrhage was not observed in any of the patients within 24 hours, and in 1 patient (0.6%) at 3 months follow up. Postoperative hematoma of any kind was observed in 9 patients (5.7%). Two other bleeding events (GI-bleeding and ear-bleeding) occurred within 3 months follow up. Coronary vascular events, defined as Troponin-I-elevation, were observed in 2 patients (1.3%) at 24 hours, and in 7 patients (4.4%) at 3 months after drug administration. Coronary intervention was necessary in 1 patient (0.6%) and 5 patients (3.1%), 24 hours and 3 months after Revacept infusion, respectively. These complications rates are comparable to the rate at day 30 follow up within the ICSS-study: ischemic stroke (91 patients 5.3%), intracerebral hemorrhage (8 patients, 0.5%) and any wound hematoma (81 patients, 4.7%)
Conclusions:
The addition of Revacept to guideline-recommended anti-thrombotic therapy in patients with symptomatic stenosis of the internal carotid artery did not increase bleeding complications within the overall study population compared to previous studies.
BACKGROUND Complicated nonstenosing carotid artery plaques (CAPs) are an under-recognized cause of stroke. OBJECTIVES The purpose of this study was to determine whether complicated CAP ipsilateral to ...acute ischemic anterior circulation stroke (icCAP) are associated with recurrent ischemic stroke or transient ischemic attack (TIA). METHODS The CAPIAS (Carotid Plaque Imaging in Acute Stroke) multicenter study prospectively recruited patients with ischemic stroke restricted to the territory of a single carotid artery. Complicated (AHA-lesion type VI) CAP were defined by multisequence, contrast-enhanced carotid magnetic resonance imaging obtained within 10 days from stroke onset. Recurrent events were assessed after 3,12, 24, and 36 months. The primary outcome was recurrent ischemic stroke or TIA. RESULTS Among 196 patients enrolled, 104 patients had cryptogenic stroke and nonstenosing CAP. During a mean follow-up of 30 months, recurrent ischemic stroke or TIA occurred in 21 patients. Recurrent events were significantly more frequent in patients with icCAP than in patients without icCAP, both in the overall cohort (incidence rate 3-year interval: 9.50 vs 3.61 per 100 patient-years;P = 0.025, log-rank test) and in patients with cryptogenic stroke (10.92 vs 1.82 per 100 patient-years;P = 0.003). The results were driven by ipsilateral events. A ruptured fibrous cap (HR: 4.91;95% CI: 1.31-18.45;P = 0.018) and intraplaque hemorrhage (HR: 4.37;95% CI: 1.20-15.97;P = 0.026) were associated with a significantly increased risk of recurrent events in patients with cryptogenic stroke. CONCLUSIONS Complicated CAP ipsilateral to acute ischemic anterior circulation stroke are associated with an increased risk of recurrent ischemic stroke or TIA. Carotid plaque imaging identifies high-risk patients who might be suited for inclusion into future secondary prevention trials. (Carotid Plaque Imaging in Acute Stroke CAPIAS;NCT01284933) (J Am Coll Cardiol 2022;79:2189-2199) (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
Background: The underlying etiology of ischemic stroke remains unknown in up to 30% of patients. OBJECTIVES This study explored the causal role of complicated (American Heart Association-lesion type ...VI) non-stenosing carotid artery plaques (CAPs) in cryptogenic stroke (CS). METHODS CAPIAS (Carotid Plaque Imaging in Acute Stroke) is an observational multicenter study that prospectively recruited patients aged older than 49 years with acute ischemic stroke that was restricted to the territory of a single carotid artery on brain magnetic resonance imaging (MRI) and unilateral or bilateral CAP (>= 2 mm, NASCET North American Symptomatic Carotid Endarterectomy Trial <70%). CAP characteristics were determined qualitatively and quantitatively by high-resolution, contrast-enhanced carotid MRI at 3T using dedicated surface coils. The pre-specified study hypotheses were that that the prevalence of complicated CAP would be higher ipsilateral to the infarct than contralateral to the infarct in CS and higher in CS compared with patients with cardioembolic or small vessel stroke (CES/SVS) as a combined reference group. Patients with large artery stroke (LAS) and NASCET 50% to 69% stenosis served as an additional comparison group. RESULTS Among 234 recruited patients, 196 had either CS (n = 104), CES/SVS (n = 79), or LAS (n = 19) and complete carotid MRI data. The prevalence of complicated CAP in patients with CS was significantly higher ipsilateral (31%) to the infarct compared with contralateral to the infarct (12%;p = 0.0005). Moreover, the prevalence of ipsilateral complicated CAP was significantly higher in CS (31%) compared with CES/SVS (15%;p = 0.02) and lower in CS compared with LAS (68%;p = 0.003). Lipid-rich and/or necrotic cores in ipsilateral CAP were significantly larger in CS compared with CES/SVS (p < 0.05). CONCLUSIONS These findings substantiate the role of complicated nonstenosing CAP as an under-recognized cause of stroke. (Carotid Plaque Imaging in Acute Stroke CAPIAS;NCT01284933) (C) 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
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