Association of Plaque Inflammation With Stroke Recurrence in Patients With Unproven Benefit From Carotid Revascularization
Por:
Camps-Renom, P, McCabe, J, Marti-Fabregas, J, Giannotti, N, Fernandez-Leon, A, McNulty, JP, Baron, JC, Barry, M, Coutts, SB, Cronin, S, Delgado-Mederos, R, Dolan, E, Foley, S, Guasch-Jimenez, M, Guisado-Alonso, D, Harbison, JA, Horgan, G, Kavanagh, EC, Marnane, M, Martinez-Domeno, A, McDonnell, C, Sharma, VK, Williams, D, Connell, MO, Murphy, S, Prats-Sanchez, L, Kelly, PJ
Publicada:
12 jul 2022
Resumen:
Background and Objectives In pooled analyses of endarterectomy trials for symptomatic carotid stenosis, several subgroups experienced no net benefit from revascularization. The validated symptomatic carotid atheroma inflammation lumen-stenosis (SCAIL) score includes stenosis severity and inflammation measured by PET and improves the identification of patients with recurrent stroke compared with lumen-stenosis alone. We investigated whether the SCAIL score improves the identification of recurrent stroke in subgroups with uncertain benefit from revascularization in endarterectomy trials. Methods We did an individual-participant data pooled analysis of 3 prospective cohort studies (Dublin Carotid Atherosclerosis Study [DUCASS], 2008-2011; Biomarkers and Imaging of Vulnerable Atherosclerosis in Symptomatic Carotid Artery Disease [BIOVASC], 2014-2018; Barcelona Plaque Study, 2015-2018). Eligible patients had a recent nonsevere (modified Rankin Scale score <= 3) anterior circulation ischemic stroke/TIA and ipsilateral mild carotid stenosis (<50%); ipsilateral moderate carotid stenosis (50%-69%) plus at least 1 of female sex, age <65 years, diabetes mellitus, TIA, or delay >14 days to revascularization; or monocular loss of vision. Patients underwent coregistered carotid F-18-fluorodeoxyglucosePET/CT angiography (<= 7 days from inclusion). The primary outcome was 90-day ipsilateral ischemic stroke. Multivariable Cox regression modeling was performed. Results We included 135 patients. All patients started optimal modern-era medical treatment at admission, and 62 (45.9%) underwent carotid revascularization (36 within the first 14 days and 26 beyond). At 90 days, 18 (13.3%) patients had experienced at least 1 stroke recurrence. The risk of recurrence increased progressively according to the SCAIL score (0.0% in patients scoring 0-1, 15.1% scoring 2-3, and 26.7% scoring 4-5; p = 0.04). The adjusted (age, smoking, hypertension, diabetes, carotid revascularization, antiplatelets and statins) hazard ratio for ipsilateral recurrent stroke per 1-point SCAIL increase was 2.16 (95% CI 1.32-3.53; p = 0.002). A score >= 2 had a sensitivity of 100% for recurrence. Discussion The SCAIL score improved the identification of early recurrent stroke in subgroups who did not experience benefit in endarterectomy trials. Randomized trials are needed to test whether a combined stenosis-inflammation strategy will improve selection for carotid revascularization when benefit is currently uncertain. Classification of Evidence This study provides Class II evidence that, in patients with recent anterior circulation ischemic stroke who do not benefit from carotid revascularization, the SCAIL score accurately distinguishes those at risk for recurrent ipsilateral ischemic stroke.
Filiaciones:
Camps-Renom, P:
Hosp Santa Creu & Sant Pau, Stroke Unit, Dept Neurol, Inst Biomed Res St Pau IIB St Pau, Barcelona, Spain
McCabe, J:
Hlth Res Board Stroke Clin Trials Network Ireland, Dublin, Ireland
Univ Coll Dublin, Neurovasc Clin Sci Unit, Mater Univ Hosp, Stroke Serv, Dublin, Ireland
Marti-Fabregas, J:
Hosp Santa Creu & Sant Pau, Stroke Unit, Dept Neurol, Inst Biomed Res St Pau IIB St Pau, Barcelona, Spain
Giannotti, N:
Univ Coll Dublin, Radiog & Diagnost Imaging, Sch Med, Dublin, Ireland
Univ Sydney, Discipline Med Imaging Sci, Sch Hlth Sci, Fac Med & Hlth, Sydney, NSW, Australia
Fernandez-Leon, A:
Hosp Santa Creu & Sant Pau, Dept Nucl Med, Barcelona, Spain
McNulty, JP:
Univ Coll Dublin, Radiog & Diagnost Imaging, Sch Med, Dublin, Ireland
Baron, JC:
Univ Paris, Hop St Anne, Dept Neurol, Paris, France
Barry, M:
St Vincents Univ Hosp, Dept Vasc Surg, Dublin, Ireland
Coutts, SB:
Univ Calgary, Dept Clin Neurosci, Calgary, AB, Canada
Univ Calgary, Dept Radiol, Calgary, AB, Canada
Univ Calgary, Dept Community Hlth Sci, Calgary, AB, Canada
Cronin, S:
Hlth Res Board Stroke Clin Trials Network Ireland, Dublin, Ireland
Cork Univ Hosp, Dept Neurol, Cork, Ireland
Univ Coll Cork, Dept Clin Neurosci, Coll Med & Hlth, Cork, Ireland
Delgado-Mederos, R:
Hosp Santa Creu & Sant Pau, Stroke Unit, Dept Neurol, Inst Biomed Res St Pau IIB St Pau, Barcelona, Spain
Dolan, E:
Hlth Res Board Stroke Clin Trials Network Ireland, Dublin, Ireland
Connolly Hosp Dublin, Dublin, Ireland
Royal Coll Surg, Dublin, Ireland
Foley, S:
Univ Coll Dublin, Radiog & Diagnost Imaging, Sch Med, Dublin, Ireland
Guasch-Jimenez, M:
Hosp Santa Creu & Sant Pau, Stroke Unit, Dept Neurol, Inst Biomed Res St Pau IIB St Pau, Barcelona, Spain
Guisado-Alonso, D:
Hosp Santa Creu & Sant Pau, Stroke Unit, Dept Neurol, Inst Biomed Res St Pau IIB St Pau, Barcelona, Spain
Harbison, JA:
Hlth Res Board Stroke Clin Trials Network Ireland, Dublin, Ireland
St James Hosp, Stroke Serv, Dept Geriatr Med, Dublin, Ireland
Horgan, G:
Hlth Res Board Stroke Clin Trials Network Ireland, Dublin, Ireland
Univ Coll Dublin, Neurovasc Clin Sci Unit, Mater Univ Hosp, Stroke Serv, Dublin, Ireland
Kavanagh, EC:
Mater Univ Hosp, Dept Radiol, Dublin, Ireland
Marnane, M:
Hlth Res Board Stroke Clin Trials Network Ireland, Dublin, Ireland
Univ Coll Dublin, Neurovasc Clin Sci Unit, Mater Univ Hosp, Stroke Serv, Dublin, Ireland
Martinez-Domeno, A:
Hosp Santa Creu & Sant Pau, Stroke Unit, Dept Neurol, Inst Biomed Res St Pau IIB St Pau, Barcelona, Spain
McDonnell, C:
Mater Univ Hosp, Dept Vasc Surg, Dublin, Ireland
Sharma, VK:
Natl Univ Hlth Syst, Div Neurol, Singapore, Singapore
Williams, D:
RCSI Univ Med & Hlth Sci, Beaumont Hosp, Dept Geriatr & Stroke Med, Dublin, Ireland
Connell, MO:
Mater Univ Hosp, Dept Radiol, Dublin, Ireland
Murphy, S:
Hlth Res Board Stroke Clin Trials Network Ireland, Dublin, Ireland
Univ Coll Dublin, Neurovasc Clin Sci Unit, Mater Univ Hosp, Stroke Serv, Dublin, Ireland
Prats-Sanchez, L:
Hosp Santa Creu & Sant Pau, Stroke Unit, Dept Neurol, Inst Biomed Res St Pau IIB St Pau, Barcelona, Spain
Kelly, PJ:
Hlth Res Board Stroke Clin Trials Network Ireland, Dublin, Ireland
Univ Coll Dublin, Neurovasc Clin Sci Unit, Mater Univ Hosp, Stroke Serv, Dublin, Ireland
Univ Coll Dublin, Mater Univ Hosp, Dept Neurol, Dublin, Ireland.
Univ Coll Dublin, Dublin, Ireland.
Trinity Coll Dublin, Dublin, Ireland.
Natl Univ Singapore, Yong Loo Lin Sch Med, Singapore, Singapore.
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