High-risk carotid plaque features may be more accurate predictors of ipsilateral ischemic stroke risk than the degree of carotid artery stenosis.
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Paraskevas Kosmas I, Saba Luca, Perler Bruce A, Aburahma Ali, Sultan Sherif, Meschia James F, Lal Brajesh K, Lyden Sean P, Malas Mahmoud B, Erben Young M, Mansilha Armando, Gargiuilo Mauro, Faggioli Gianluca, Pini Rodolfo, White Christopher J, Abularrage Christopher J, Spinelli Francesco, Blecha Matthew, Dardik Alan, Myrcha Piotr, Lanza Gaetano, Spinetti Gaia, Menyhei Gabor, Bruno Antonino, Ringleb Peter Arthur, Reiff Tilman, Stilo Francesco, Mikhailidis Dimitri P, Gray William A, Jawien Arkadiusz, D'Oria Mario, Svetlikov Alexei, Silvestrini Mauro, Poredos Pavel, Fernandes E Fernandes Jose, DI Lazzaro Vincenzo, Eldrup-Jorgensen Jens, Gurevich Victor, Liapis Christos D, Stone David H, Schneider Peter A, Gallitto Enrico, Dermody Meghan, Vacirca Andrea, Sawicka Agnieszka, Sufali Gemmi, Mackevicius Arturas, Baltrunas Tomas, Kashyap Vikram S, Zeebregts Clark J, Musialek Piotr, Setacci Carlo, Schermerhorn Marc L, Lip Gregory Y, Nicolaides Andrew N, Chaturvedi Seemant
Аннотация
EVIDENCE ACQUISITION: We reviewed the literature for evidence supporting an association between high-risk carotid plaque features with ipsilateral ischemic stroke risk.
EVIDENCE SYNTHESIS: Certain carotid plaque features, such as intraplaque hemorrhage, lipid-rich necrotic core, thinning/rupture of the fibrous cap, ulceration, or neovascularization, may more accurately stratify patients at low vs. high future stroke risk. The presence of ≥1 "high-risk" carotid plaque characteristics can inform decisions on the conservative vs. invasive management of AsxCS patients and target carotid revascularization procedures to those AsxCS patient subgroups at high stroke risk who are more likely to benefit from them.
CONCLUSIONS: The present article presents the rationale supporting stratification of AsxCS patients not based on the degree of stenosis, but on the presence of one or more specific high-risk plaque features that increase the risk of a future ipsilateral ischemic cerebrovascular event.