Is angiography still the best method to stratify stroke risk in symptomatic atherosclerotic carotid plaque?
Author(s)
Gustavo W. Kuster*,
A. J. Da Rocha,
A. S. F. Silva,
R. A. Valiente,
M. S. G. Rocha,
A. R. Massaro
Affiliation(s)
Division of Neurology, S?o Paulo University, S?o Paulo, Brazil . Department of Radiology and Pathology, Fleury Institute, S?o Paulo, Brazil . Division of Neurology, Santa Marcelina Hospital, S?o Paulo, Brazil . Sao Paulo University, S?o Paulo, Brazil .
Division of Neurology, S?o Paulo University, S?o Paulo, Brazil . Department of Radiology and Pathology, Fleury Institute, S?o Paulo, Brazil . Division of Neurology, Santa Marcelina Hospital, S?o Paulo, Brazil . Sao Paulo University, S?o Paulo, Brazil .
ABSTRACT
The degree of vessel lumen narrowing is an independent predictor of ischemic stroke. New developments in carotid plaque morphology imaging (MR, CT), may bring new insights to the relationship between carotid atherosclerotic disease and stroke risk. Our aim is to review the stroke risk in a symptomatic patient with moderate carotid stenosis by CT imaging and histopathology. A 72-year-old patient with low ABCD2 scores TIA and moderate left internal carotid stenosis (50% by carotid ultrasound), was discharged with an optimized medical therapy. Four months later, he presented an ischemic stroke in the left frontal area. Carotid angiography showed a 60% stenosis in the left-internal carotid artery with a regular surface. CT plaque imaging detected a thin fibrous cap with calcification and an intraplaque hemorrhage (high-risk plaque). These findings were confirmed in the histolopathological study of the atherosclerotic plaque performed after the endarterectomy. After 1 year of follow-up, the patient returned independently to his daily activities. We propose, in this study, the inclusion of noninvasive plaque imaging in the evaluation of acute TIA with moderate carotid stenosis to better select patients with higher risk of stroke recurrence.
The degree of vessel lumen narrowing is an independent predictor of ischemic stroke. New developments in carotid plaque morphology imaging (MR, CT), may bring new insights to the relationship between carotid atherosclerotic disease and stroke risk. Our aim is to review the stroke risk in a symptomatic patient with moderate carotid stenosis by CT imaging and histopathology. A 72-year-old patient with low ABCD2 scores TIA and moderate left internal carotid stenosis (50% by carotid ultrasound), was discharged with an optimized medical therapy. Four months later, he presented an ischemic stroke in the left frontal area. Carotid angiography showed a 60% stenosis in the left-internal carotid artery with a regular surface. CT plaque imaging detected a thin fibrous cap with calcification and an intraplaque hemorrhage (high-risk plaque). These findings were confirmed in the histolopathological study of the atherosclerotic plaque performed after the endarterectomy. After 1 year of follow-up, the patient returned independently to his daily activities. We propose, in this study, the inclusion of noninvasive plaque imaging in the evaluation of acute TIA with moderate carotid stenosis to better select patients with higher risk of stroke recurrence.
Cite this paper
Kuster, G. , Rocha, A. , Silva, A. , Valiente, R. , Rocha, M. and Massaro, A. (2013) Is angiography still the best method to stratify stroke risk in symptomatic atherosclerotic carotid plaque?. Case Reports in Clinical Medicine, 2, 470-472. doi: 10.4236/crcm.2013.28124.
Kuster, G. , Rocha, A. , Silva, A. , Valiente, R. , Rocha, M. and Massaro, A. (2013) Is angiography still the best method to stratify stroke risk in symptomatic atherosclerotic carotid plaque?. Case Reports in Clinical Medicine, 2, 470-472. doi: 10.4236/crcm.2013.28124.
References
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[1] Allam, A.H., Thompson, R.C., Wann, L.S., et al. (2011) Atherosclerosis in ancient Egyptian mummies; the Horus study. JACC Cardiovasc Imaging, 4, 315-327.
http://dx.doi.org/10.1016/j.jcmg.2011.02.002 [2] North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high grade carotid stenosis. The New England Journal of Medicine, 325, 445-453.
http://dx.doi.org/10.1056/NEJM199108153250701 [3] Barnett, J.J.M., Taylor, D.W., Eliasziw, M. et al. (1998) Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. The New England Journal of Medicine, 339, 1415-1425.
http://dx.doi.org/10.1056/NEJM199811123392002 [4] Marquadt, L., Geraghty, O.C., Mehta, Z. and Rothwell, P.M. (2010) Low risk of ipsilateral stroke in patients with asymptomatic carotid stenosis on best medical treatment: A prospective, population-based study. Stroke, 41, e11-e17. http://dx.doi.org/10.1161/STROKEAHA.109.561837 [5] Wintermark, M., Jawadi, S.S., Rapp, J.H., et al. (2008) High-resolution CT imagin of carotid artery atherosclerotic plaques. American Journal of Neuroradiology, 29, 875-882. http://dx.doi.org/10.3174/ajnr.A0950 [6] Saam, T., Cai, J., Ma, L., Cai, Y.Q., et al. (2006) Comparison of symptomatic and asymptomatic atherosclerotic plaques features with in vivo MR imaging. Radiology, 20, 464-472. http://dx.doi.org/10.1148/radiol.2402050390 [7] Stary, H.C., Chandler, A.B. and Dinsmore, R.E., American Heart Association (1995) A definition types of atherosclerotic lesions and a histological classification of atherosclerosis: A report from the Committee on vascular lesions of the council on atherosclerosis. Circulation, 92, 1355-1374. http://dx.doi.org/10.1161/01.CIR.92.5.1355