Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

Andrew N. Nicolaides; Stavros K. Kakkos; Efthyvoulos Kyriacou; Maura Griffin; Michael Sabetai; Dafydd J. Thomas; Thomas Tegos; George Geroulakos; Nicos Labropoulos; Caroline J. Dor; Tim P. Morris; Ross Naylor; Anne L. Abbott; R. Adovasio; B. Ziani; F. P. Alò; C. G. Cicilioni; G. Ambrosio; A. Andreev; G. M. Andreozzi; F. Verlato; G. Camporese; E. Arosio; E. Barkauskas; A. A.B. Barros D'Sa; P. Brannigan; V. Batchvarova; A. Dramov; P. Belardi; G. P. Novelli; G. Simoni; P. Bell; G. M. Biasi; P. Mingazzini; N. M. Bornstein; D. Bouchier-Hayes; P. Fitzgerald; M. A. Cairols; P. G. Cao; P. DeRango; G. P. Carboni; C. Geoffredo; M. Catalano; B. Chambers; M. Goetzmann; A. Dickinson; D. Clement; M. Bobelyn; S. Coccheri; E. Conti; E. Diamantopoulos; E. A. Andreadis; P. B. Dimakakos; T. Kotsis; B. Eikelboom; L. Entz; Ferrari-Bardile; T. Aloi; M. Salerno; J. Fernandes e Fernandes; L. Pedro; D. E. Fitzgerald; A. O'Shaunnersy; J. Fletcher; S. Forconi; R. Cappeli; M. Bicchi; S. Arrigucci; V. Gallai; G. Cardaiolli; G. Geroulakos; L. F. Gomez-Isaza; G. Gorgoyannis; N. Liasis; M. Graf; P. Guarini; S. Hardy; P. Harris; S. Aston; G. Iosa; A. Katsamouris; A. Giannoukas; M. Krzanowski; G. Ladurner; J. Leal-Monedero; B. B. Lee; C. Liapis; P. Galanis; W. Liboni; E. Pavanelli; E. Mannarino; G. Vaudo; P. McCollum; R. Levison; G. Micieli; D. Bosone; L. Middleton; M. Pantziaris; T. Tyllis; E. Minar; A. Willfort; L. Moggi; G. Nenci; S. Radicchia; A. Nicolaides; D. Thomas; L. Norgren; E. Ribbe; S. Novo; R. Tantillo; D. Olinic; W. Paaske; A. Pagnan; P. Pauletto; V. Pagliara; G. Pettina; C. Pratesi; S. Matticari; J. Polivka; P. Sevcik; P. Poredos; A. Blinc; V. Videcnik; A. Pujia; A. Raso; P. Rispoli; M. Conforti; T. Robinson; M. S.J. Dennis; S. Rosfors; G. Rudofsky; T. Schroeder; M. L. Gronholdt; G. Simoni; C. Finocchi; G. Rodriguez; C. Spartera; M. Ventura; P. Scarpelli; M. Sprynger; B. Sadzot; C. Hottermans; Moonen; P. R. Taylor; A. Tovar-Pardo; J. Negreira; M. Vayssairat; J. M. Faintuch; J. Valaikiené; M. G. Walker; A. R. Wilkinson

doi:10.1016/j.jvs.2010.07.021

Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

Andrew N. Nicolaides^*, Stavros K. Kakkos, Efthyvoulos Kyriacou, Maura Griffin, Michael Sabetai, Dafydd J. Thomas, Thomas Tegos, George Geroulakos, Nicos Labropoulos, Caroline J. Dor, Tim P. Morris, Ross Naylor, Anne L. Abbott, R. Adovasio, B. Ziani, F. P. Alò, C. G. Cicilioni, G. Ambrosio, A. Andreev, G. M. AndreozziF. Verlato, G. Camporese, E. Arosio, E. Barkauskas, A. A.B. Barros D'Sa, P. Brannigan, V. Batchvarova, A. Dramov, P. Belardi, G. P. Novelli, G. Simoni, P. Bell, G. M. Biasi, P. Mingazzini, N. M. Bornstein, D. Bouchier-Hayes, P. Fitzgerald, M. A. Cairols, P. G. Cao, P. DeRango, G. P. Carboni, C. Geoffredo, M. Catalano, B. Chambers, M. Goetzmann, A. Dickinson, D. Clement, M. Bobelyn, S. Coccheri, E. Conti, E. Diamantopoulos, E. A. Andreadis, P. B. Dimakakos, T. Kotsis, B. Eikelboom, L. Entz, Ferrari-Bardile, T. Aloi, M. Salerno, J. Fernandes e Fernandes, L. Pedro, D. E. Fitzgerald, A. O'Shaunnersy, J. Fletcher, S. Forconi, R. Cappeli, M. Bicchi, S. Arrigucci, V. Gallai, G. Cardaiolli, G. Geroulakos, L. F. Gomez-Isaza, G. Gorgoyannis, N. Liasis, M. Graf, P. Guarini, S. Hardy, P. Harris, S. Aston, G. Iosa, A. Katsamouris, A. Giannoukas, M. Krzanowski, G. Ladurner, J. Leal-Monedero, B. B. Lee, C. Liapis, P. Galanis, W. Liboni, E. Pavanelli, E. Mannarino, G. Vaudo, P. McCollum, R. Levison, G. Micieli, D. Bosone, L. Middleton, M. Pantziaris, T. Tyllis, E. Minar, A. Willfort, L. Moggi, G. Nenci, S. Radicchia, A. Nicolaides, D. Thomas, L. Norgren, E. Ribbe, S. Novo, R. Tantillo, D. Olinic, W. Paaske, A. Pagnan, P. Pauletto, V. Pagliara, G. Pettina, C. Pratesi, S. Matticari, J. Polivka, P. Sevcik, P. Poredos, A. Blinc, V. Videcnik, A. Pujia, A. Raso, P. Rispoli, M. Conforti, T. Robinson, M. S.J. Dennis, S. Rosfors, G. Rudofsky, T. Schroeder, M. L. Gronholdt, G. Simoni, C. Finocchi, G. Rodriguez, C. Spartera, M. Ventura, P. Scarpelli, M. Sprynger, B. Sadzot, C. Hottermans, Moonen, P. R. Taylor, A. Tovar-Pardo, J. Negreira, M. Vayssairat, J. M. Faintuch, J. Valaikiené, M. G. Walker, A. R. Wilkinson

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

300 Scopus citations

Abstract

Background The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis. Methods This was a prospective, multicenter, cohort study of patients undergoing medical intervention for vascular disease. Hazard ratios for ICA stenosis, clinical features, and plaque texture features associated with ipsilateral cerebrovascular or retinal ischemic (CORI) events were calculated using proportional hazards models. Results A total of 1121 patients with 50% to 99% asymptomatic ICA stenosis in relation to the bulb (European Carotid Surgery Trial [ECST] method) were followed-up for 6 to 96 months (mean, 48). A total of 130 ipsilateral CORI events occurred. Severity of stenosis, age, systolic blood pressure, increased serum creatinine, smoking history of more than 10 pack-years, history of contralateral transient ischemic attacks (TIAs) or stroke, low grayscale median (GSM), increased plaque area, plaque types 1, 2, and 3, and the presence of discrete white areas (DWAs) without acoustic shadowing were associated with increased risk. Receiver operating characteristic (ROC) curves were constructed for predicted risk versus observed CORI events as a measure of model validity. The areas under the ROC curves for a model of stenosis alone, a model of stenosis combined with clinical features and a model of stenosis combined with clinical, and plaque features were 0.59 (95% confidence interval [CI] 0.54-0.64), 0.66 (0.62-0.72), and 0.82 (0.78-0.86), respectively. In the last model, stenosis, history of contralateral TIAs or stroke, GSM, plaque area, and DWAs were independent predictors of ipsilateral CORI events. Combinations of these could stratify patients into different levels of risk for ipsilateral CORI and stroke, with predicted risk close to observed risk. Of the 923 patients with <70% stenosis, the predicted cumulative 5-year stroke rate was <5% in 495, 5% to 9.9% in 202, 10% to 19.9% in 142, and <20% in 84 patients. Conclusion Cerebrovascular risk stratification is possible using a combination of clinical and ultrasonic plaque features. These findings need to be validated in additional prospective studies of patients receiving optimal medical intervention alone.

Original language	English
Pages (from-to)	1496.e5
Journal	Journal of Vascular Surgery
Volume	52
Issue number	6
DOIs	https://doi.org/10.1016/j.jvs.2010.07.021
State	Published - Dec 2010
Externally published	Yes

Funding

Funders	Funder number
CDER Trust
European Commission	PL 650629

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jvs.2010.07.021

Cite this

Nicolaides, A. N., Kakkos, S. K., Kyriacou, E., Griffin, M., Sabetai, M., Thomas, D. J., Tegos, T., Geroulakos, G., Labropoulos, N., Dor, C. J., Morris, T. P., Naylor, R., Abbott, A. L., Adovasio, R., Ziani, B., Alò, F. P., Cicilioni, C. G., Ambrosio, G., Andreev, A., ... Wilkinson, A. R. (2010). Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification. Journal of Vascular Surgery, 52(6), 1496.e5. https://doi.org/10.1016/j.jvs.2010.07.021

@article{33419c8b3cdf44329e9a9785037a53b2,

title = "Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification",

abstract = "Background The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis. Methods This was a prospective, multicenter, cohort study of patients undergoing medical intervention for vascular disease. Hazard ratios for ICA stenosis, clinical features, and plaque texture features associated with ipsilateral cerebrovascular or retinal ischemic (CORI) events were calculated using proportional hazards models. Results A total of 1121 patients with 50% to 99% asymptomatic ICA stenosis in relation to the bulb (European Carotid Surgery Trial [ECST] method) were followed-up for 6 to 96 months (mean, 48). A total of 130 ipsilateral CORI events occurred. Severity of stenosis, age, systolic blood pressure, increased serum creatinine, smoking history of more than 10 pack-years, history of contralateral transient ischemic attacks (TIAs) or stroke, low grayscale median (GSM), increased plaque area, plaque types 1, 2, and 3, and the presence of discrete white areas (DWAs) without acoustic shadowing were associated with increased risk. Receiver operating characteristic (ROC) curves were constructed for predicted risk versus observed CORI events as a measure of model validity. The areas under the ROC curves for a model of stenosis alone, a model of stenosis combined with clinical features and a model of stenosis combined with clinical, and plaque features were 0.59 (95% confidence interval [CI] 0.54-0.64), 0.66 (0.62-0.72), and 0.82 (0.78-0.86), respectively. In the last model, stenosis, history of contralateral TIAs or stroke, GSM, plaque area, and DWAs were independent predictors of ipsilateral CORI events. Combinations of these could stratify patients into different levels of risk for ipsilateral CORI and stroke, with predicted risk close to observed risk. Of the 923 patients with <70% stenosis, the predicted cumulative 5-year stroke rate was <5% in 495, 5% to 9.9% in 202, 10% to 19.9% in 142, and <20% in 84 patients. Conclusion Cerebrovascular risk stratification is possible using a combination of clinical and ultrasonic plaque features. These findings need to be validated in additional prospective studies of patients receiving optimal medical intervention alone.",

author = "Nicolaides, {Andrew N.} and Kakkos, {Stavros K.} and Efthyvoulos Kyriacou and Maura Griffin and Michael Sabetai and Thomas, {Dafydd J.} and Thomas Tegos and George Geroulakos and Nicos Labropoulos and Dor, {Caroline J.} and Morris, {Tim P.} and Ross Naylor and Abbott, {Anne L.} and R. Adovasio and B. Ziani and Al{\`o}, {F. P.} and Cicilioni, {C. G.} and G. Ambrosio and A. Andreev and Andreozzi, {G. M.} and F. Verlato and G. Camporese and E. Arosio and E. Barkauskas and {Barros D'Sa}, {A. A.B.} and P. Brannigan and V. Batchvarova and A. Dramov and P. Belardi and Novelli, {G. P.} and G. Simoni and P. Bell and Biasi, {G. M.} and P. Mingazzini and Bornstein, {N. M.} and D. Bouchier-Hayes and P. Fitzgerald and Cairols, {M. A.} and Cao, {P. G.} and P. DeRango and Carboni, {G. P.} and C. Geoffredo and M. Catalano and B. Chambers and M. Goetzmann and A. Dickinson and D. Clement and M. Bobelyn and S. Coccheri and E. Conti and E. Diamantopoulos and Andreadis, {E. A.} and Dimakakos, {P. B.} and T. Kotsis and B. Eikelboom and L. Entz and Ferrari-Bardile and T. Aloi and M. Salerno and {Fernandes e Fernandes}, J. and L. Pedro and Fitzgerald, {D. E.} and A. O'Shaunnersy and J. Fletcher and S. Forconi and R. Cappeli and M. Bicchi and S. Arrigucci and V. Gallai and G. Cardaiolli and G. Geroulakos and Gomez-Isaza, {L. F.} and G. Gorgoyannis and N. Liasis and M. Graf and P. Guarini and S. Hardy and P. Harris and S. Aston and G. Iosa and A. Katsamouris and A. Giannoukas and M. Krzanowski and G. Ladurner and J. Leal-Monedero and Lee, {B. B.} and C. Liapis and P. Galanis and W. Liboni and E. Pavanelli and E. Mannarino and G. Vaudo and P. McCollum and R. Levison and G. Micieli and D. Bosone and L. Middleton and M. Pantziaris and T. Tyllis and E. Minar and A. Willfort and L. Moggi and G. Nenci and S. Radicchia and A. Nicolaides and D. Thomas and L. Norgren and E. Ribbe and S. Novo and R. Tantillo and D. Olinic and W. Paaske and A. Pagnan and P. Pauletto and V. Pagliara and G. Pettina and C. Pratesi and S. Matticari and J. Polivka and P. Sevcik and P. Poredos and A. Blinc and V. Videcnik and A. Pujia and A. Raso and P. Rispoli and M. Conforti and T. Robinson and Dennis, {M. S.J.} and S. Rosfors and G. Rudofsky and T. Schroeder and Gronholdt, {M. L.} and G. Simoni and C. Finocchi and G. Rodriguez and C. Spartera and M. Ventura and P. Scarpelli and M. Sprynger and B. Sadzot and C. Hottermans and Moonen and Taylor, {P. R.} and A. Tovar-Pardo and J. Negreira and M. Vayssairat and Faintuch, {J. M.} and J. Valaikien{\'e} and Walker, {M. G.} and Wilkinson, {A. R.}",

note = "Funding Information: The study was supported by a grant from the European Commission (Biomed II) Program (PL 650629) for the first 3 years and subsequently by a grant from the CDER Trust (UK), 30 Weymouth street, London W1G 7BS, UK. ",

year = "2010",

month = dec,

doi = "10.1016/j.jvs.2010.07.021",

language = "אנגלית",

volume = "52",

pages = "1496.e5",

journal = "Journal of Vascular Surgery",

issn = "0741-5214",

publisher = "Elsevier Inc.",

number = "6",

}

Nicolaides, AN, Kakkos, SK, Kyriacou, E, Griffin, M, Sabetai, M, Thomas, DJ, Tegos, T, Geroulakos, G, Labropoulos, N, Dor, CJ, Morris, TP, Naylor, R, Abbott, AL, Adovasio, R, Ziani, B, Alò, FP, Cicilioni, CG, Ambrosio, G, Andreev, A, Andreozzi, GM, Verlato, F, Camporese, G, Arosio, E, Barkauskas, E, Barros D'Sa, AAB, Brannigan, P, Batchvarova, V, Dramov, A, Belardi, P, Novelli, GP, Simoni, G, Bell, P, Biasi, GM, Mingazzini, P, Bornstein, NM, Bouchier-Hayes, D, Fitzgerald, P, Cairols, MA, Cao, PG, DeRango, P, Carboni, GP, Geoffredo, C, Catalano, M, Chambers, B, Goetzmann, M, Dickinson, A, Clement, D, Bobelyn, M, Coccheri, S, Conti, E, Diamantopoulos, E, Andreadis, EA, Dimakakos, PB, Kotsis, T, Eikelboom, B, Entz, L, Ferrari-Bardile, Aloi, T, Salerno, M, Fernandes e Fernandes, J, Pedro, L, Fitzgerald, DE, O'Shaunnersy, A, Fletcher, J, Forconi, S, Cappeli, R, Bicchi, M, Arrigucci, S, Gallai, V, Cardaiolli, G, Geroulakos, G, Gomez-Isaza, LF, Gorgoyannis, G, Liasis, N, Graf, M, Guarini, P, Hardy, S, Harris, P, Aston, S, Iosa, G, Katsamouris, A, Giannoukas, A, Krzanowski, M, Ladurner, G, Leal-Monedero, J, Lee, BB, Liapis, C, Galanis, P, Liboni, W, Pavanelli, E, Mannarino, E, Vaudo, G, McCollum, P, Levison, R, Micieli, G, Bosone, D, Middleton, L, Pantziaris, M, Tyllis, T, Minar, E, Willfort, A, Moggi, L, Nenci, G, Radicchia, S, Nicolaides, A, Thomas, D, Norgren, L, Ribbe, E, Novo, S, Tantillo, R, Olinic, D, Paaske, W, Pagnan, A, Pauletto, P, Pagliara, V, Pettina, G, Pratesi, C, Matticari, S, Polivka, J, Sevcik, P, Poredos, P, Blinc, A, Videcnik, V, Pujia, A, Raso, A, Rispoli, P, Conforti, M, Robinson, T, Dennis, MSJ, Rosfors, S, Rudofsky, G, Schroeder, T, Gronholdt, ML, Simoni, G, Finocchi, C, Rodriguez, G, Spartera, C, Ventura, M, Scarpelli, P, Sprynger, M, Sadzot, B, Hottermans, C, Moonen, Taylor, PR, Tovar-Pardo, A, Negreira, J, Vayssairat, M, Faintuch, JM, Valaikiené, J, Walker, MG & Wilkinson, AR 2010, 'Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification', Journal of Vascular Surgery, vol. 52, no. 6, pp. 1496.e5. https://doi.org/10.1016/j.jvs.2010.07.021

TY - JOUR

T1 - Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

AU - Nicolaides, Andrew N.

AU - Kakkos, Stavros K.

AU - Kyriacou, Efthyvoulos

AU - Griffin, Maura

AU - Sabetai, Michael

AU - Thomas, Dafydd J.

AU - Tegos, Thomas

AU - Geroulakos, George

AU - Labropoulos, Nicos

AU - Dor, Caroline J.

AU - Morris, Tim P.

AU - Naylor, Ross

AU - Abbott, Anne L.

AU - Adovasio, R.

AU - Ziani, B.

AU - Alò, F. P.

AU - Cicilioni, C. G.

AU - Ambrosio, G.

AU - Andreev, A.

AU - Andreozzi, G. M.

AU - Verlato, F.

AU - Camporese, G.

AU - Arosio, E.

AU - Barkauskas, E.

AU - Barros D'Sa, A. A.B.

AU - Brannigan, P.

AU - Batchvarova, V.

AU - Dramov, A.

AU - Belardi, P.

AU - Novelli, G. P.

AU - Simoni, G.

AU - Bell, P.

AU - Biasi, G. M.

AU - Mingazzini, P.

AU - Bornstein, N. M.

AU - Bouchier-Hayes, D.

AU - Fitzgerald, P.

AU - Cairols, M. A.

AU - Cao, P. G.

AU - DeRango, P.

AU - Carboni, G. P.

AU - Geoffredo, C.

AU - Catalano, M.

AU - Chambers, B.

AU - Goetzmann, M.

AU - Dickinson, A.

AU - Clement, D.

AU - Bobelyn, M.

AU - Coccheri, S.

AU - Conti, E.

AU - Diamantopoulos, E.

AU - Andreadis, E. A.

AU - Dimakakos, P. B.

AU - Kotsis, T.

AU - Eikelboom, B.

AU - Entz, L.

AU - Ferrari-Bardile,

AU - Aloi, T.

AU - Salerno, M.

AU - Fernandes e Fernandes, J.

AU - Pedro, L.

AU - Fitzgerald, D. E.

AU - O'Shaunnersy, A.

AU - Fletcher, J.

AU - Forconi, S.

AU - Cappeli, R.

AU - Bicchi, M.

AU - Arrigucci, S.

AU - Gallai, V.

AU - Cardaiolli, G.

AU - Geroulakos, G.

AU - Gomez-Isaza, L. F.

AU - Gorgoyannis, G.

AU - Liasis, N.

AU - Graf, M.

AU - Guarini, P.

AU - Hardy, S.

AU - Harris, P.

AU - Aston, S.

AU - Iosa, G.

AU - Katsamouris, A.

AU - Giannoukas, A.

AU - Krzanowski, M.

AU - Ladurner, G.

AU - Leal-Monedero, J.

AU - Lee, B. B.

AU - Liapis, C.

AU - Galanis, P.

AU - Liboni, W.

AU - Pavanelli, E.

AU - Mannarino, E.

AU - Vaudo, G.

AU - McCollum, P.

AU - Levison, R.

AU - Micieli, G.

AU - Bosone, D.

AU - Middleton, L.

AU - Pantziaris, M.

AU - Tyllis, T.

AU - Minar, E.

AU - Willfort, A.

AU - Moggi, L.

AU - Nenci, G.

AU - Radicchia, S.

AU - Nicolaides, A.

AU - Thomas, D.

AU - Norgren, L.

AU - Ribbe, E.

AU - Novo, S.

AU - Tantillo, R.

AU - Olinic, D.

AU - Paaske, W.

AU - Pagnan, A.

AU - Pauletto, P.

AU - Pagliara, V.

AU - Pettina, G.

AU - Pratesi, C.

AU - Matticari, S.

AU - Polivka, J.

AU - Sevcik, P.

AU - Poredos, P.

AU - Blinc, A.

AU - Videcnik, V.

AU - Pujia, A.

AU - Raso, A.

AU - Rispoli, P.

AU - Conforti, M.

AU - Robinson, T.

AU - Dennis, M. S.J.

AU - Rosfors, S.

AU - Rudofsky, G.

AU - Schroeder, T.

AU - Gronholdt, M. L.

AU - Simoni, G.

AU - Finocchi, C.

AU - Rodriguez, G.

AU - Spartera, C.

AU - Ventura, M.

AU - Scarpelli, P.

AU - Sprynger, M.

AU - Sadzot, B.

AU - Hottermans, C.

AU - Moonen,

AU - Taylor, P. R.

AU - Tovar-Pardo, A.

AU - Negreira, J.

AU - Vayssairat, M.

AU - Faintuch, J. M.

AU - Valaikiené, J.

AU - Walker, M. G.

AU - Wilkinson, A. R.

N1 - Funding Information: The study was supported by a grant from the European Commission (Biomed II) Program (PL 650629) for the first 3 years and subsequently by a grant from the CDER Trust (UK), 30 Weymouth street, London W1G 7BS, UK.

PY - 2010/12

Y1 - 2010/12

N2 - Background The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis. Methods This was a prospective, multicenter, cohort study of patients undergoing medical intervention for vascular disease. Hazard ratios for ICA stenosis, clinical features, and plaque texture features associated with ipsilateral cerebrovascular or retinal ischemic (CORI) events were calculated using proportional hazards models. Results A total of 1121 patients with 50% to 99% asymptomatic ICA stenosis in relation to the bulb (European Carotid Surgery Trial [ECST] method) were followed-up for 6 to 96 months (mean, 48). A total of 130 ipsilateral CORI events occurred. Severity of stenosis, age, systolic blood pressure, increased serum creatinine, smoking history of more than 10 pack-years, history of contralateral transient ischemic attacks (TIAs) or stroke, low grayscale median (GSM), increased plaque area, plaque types 1, 2, and 3, and the presence of discrete white areas (DWAs) without acoustic shadowing were associated with increased risk. Receiver operating characteristic (ROC) curves were constructed for predicted risk versus observed CORI events as a measure of model validity. The areas under the ROC curves for a model of stenosis alone, a model of stenosis combined with clinical features and a model of stenosis combined with clinical, and plaque features were 0.59 (95% confidence interval [CI] 0.54-0.64), 0.66 (0.62-0.72), and 0.82 (0.78-0.86), respectively. In the last model, stenosis, history of contralateral TIAs or stroke, GSM, plaque area, and DWAs were independent predictors of ipsilateral CORI events. Combinations of these could stratify patients into different levels of risk for ipsilateral CORI and stroke, with predicted risk close to observed risk. Of the 923 patients with <70% stenosis, the predicted cumulative 5-year stroke rate was <5% in 495, 5% to 9.9% in 202, 10% to 19.9% in 142, and <20% in 84 patients. Conclusion Cerebrovascular risk stratification is possible using a combination of clinical and ultrasonic plaque features. These findings need to be validated in additional prospective studies of patients receiving optimal medical intervention alone.

AB - Background The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis. Methods This was a prospective, multicenter, cohort study of patients undergoing medical intervention for vascular disease. Hazard ratios for ICA stenosis, clinical features, and plaque texture features associated with ipsilateral cerebrovascular or retinal ischemic (CORI) events were calculated using proportional hazards models. Results A total of 1121 patients with 50% to 99% asymptomatic ICA stenosis in relation to the bulb (European Carotid Surgery Trial [ECST] method) were followed-up for 6 to 96 months (mean, 48). A total of 130 ipsilateral CORI events occurred. Severity of stenosis, age, systolic blood pressure, increased serum creatinine, smoking history of more than 10 pack-years, history of contralateral transient ischemic attacks (TIAs) or stroke, low grayscale median (GSM), increased plaque area, plaque types 1, 2, and 3, and the presence of discrete white areas (DWAs) without acoustic shadowing were associated with increased risk. Receiver operating characteristic (ROC) curves were constructed for predicted risk versus observed CORI events as a measure of model validity. The areas under the ROC curves for a model of stenosis alone, a model of stenosis combined with clinical features and a model of stenosis combined with clinical, and plaque features were 0.59 (95% confidence interval [CI] 0.54-0.64), 0.66 (0.62-0.72), and 0.82 (0.78-0.86), respectively. In the last model, stenosis, history of contralateral TIAs or stroke, GSM, plaque area, and DWAs were independent predictors of ipsilateral CORI events. Combinations of these could stratify patients into different levels of risk for ipsilateral CORI and stroke, with predicted risk close to observed risk. Of the 923 patients with <70% stenosis, the predicted cumulative 5-year stroke rate was <5% in 495, 5% to 9.9% in 202, 10% to 19.9% in 142, and <20% in 84 patients. Conclusion Cerebrovascular risk stratification is possible using a combination of clinical and ultrasonic plaque features. These findings need to be validated in additional prospective studies of patients receiving optimal medical intervention alone.

UR - http://www.scopus.com/inward/record.url?scp=84864739554&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2010.07.021

DO - 10.1016/j.jvs.2010.07.021

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AN - SCOPUS:84864739554

SN - 0741-5214

VL - 52

SP - 1496.e5

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

IS - 6

ER -

Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

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UN SDGs

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