Carotid Plaque Inflammation Imaged by F-18-Fluorodeoxyglucose Positron Emission Tomography and Risk of Early Recurrent Stroke
Por:
Kelly, PJ, Camps-Renom, P, Giannotti, N, Marti-Fabregas, J, Murphy, S, McNulty, J, Barry, M, Barry, P, Calvet, D, Coutts, SB, Cronin, S, Delgado-Mederos, R, Dolan, E, Fernandez-Leon, A, Foley, S, Harbison, J, Horgan, G, Kavanagh, E, Marnane, M, McDonnell, C, O'Donohoe, M, Sharma, V, Walsh, C, Williams, D, O'Connell, M
Publicada:
1 jul 2019
Resumen:
Background and Purpose- Plaque inflammation contributes to stroke and coronary events. F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) identifies plaque inflammation-related metabolism. Almost no prospective data exist on the relationship of carotid F-18-FDG uptake and early recurrent stroke. Methods- We did a multicenter prospective cohort study BIOVASC (Biomarkers/Imaging Vulnerable Atherosclerosis in Symptomatic Carotid disease) of patients with carotid stenosis and recent stroke/transient ischemic attack with 90-day follow-up. On coregistered carotid F-18-FDG PET/computed tomography angiography, F-18-FDG uptake was expressed as maximum standardized uptake value (SUVmax) in the axial single hottest slice. We then conducted a systematic review of similar studies and pooled unpublished individual-patient data with 2 highly similar independent studies (Dublin and Barcelona). We analyzed the association of SUVmax with all recurrent nonprocedural stroke (before and after PET) and with recurrent stroke after PET only. Results- In BIOVASC (n=109, 14 recurrent strokes), after adjustment (for age, sex, stenosis severity, antiplatelets, statins, diabetes mellitus, hypertension, and smoking), the hazard ratio for recurrent stroke per 1 g/mL SUVmax was 2.2 (CI, 1.1-4.5; P=0.025). Findings were consistent in the independent Dublin (n=52, hazard ratio, 2.2; CI, 1.1-4.3) and Barcelona studies (n=35, hazard ratio, 2.8; CI, 0.98-5.5). In the pooled cohort (n=196), 37 recurrent strokes occurred (29 before and 8 after PET). Plaque SUVmax was higher in patients with all recurrence (P<0.0001) and post-PET recurrence (P=0.009). The fully adjusted hazard ratio of any recurrent stroke was 2.19 (CI, 1.41-3.39; P<0.001) and for post-PET recurrent stroke was 4.57 (CI, 1.5-13.96; P=0.008). Recurrent stroke risk increased across SUVmax quartiles (log-rank P=0.003). The area under receiver operating curve for all recurrence was 0.70 (CI, 0.59-0.78) and for post-PET recurrence was 0.80 (CI, 0.64-0.96). Conclusions- Plaque inflammation-related F-18-FDG uptake independently predicted future recurrent stroke post-PET. Although further studies are needed, F-18-FDG PET may improve patient selection for carotid revascularization and suggest that anti-inflammatory agents may have benefit for poststroke vascular prevention.
Filiaciones:
Kelly, PJ:
Univ Coll Dublin, Neurovasc Clin Sci Unit, Stroke Serv, Dublin, Ireland
Univ Coll Dublin, Dept Neurol, Dublin, Ireland
Univ Autonoma Barcelona, HRB Stroke Clin Trials Network Ireland, Barcelona, Spain
Camps-Renom, P:
Univ Autonoma Barcelona, Dept Neurol, Hosp Santa Creu & St Pau, Biomed Res Inst St Pau IIB St Pau, Barcelona, Spain
Giannotti, N:
Univ Coll Dublin, Neurovasc Clin Sci Unit, Stroke Serv, Dublin, Ireland
Univ Coll Dublin, Dept Neurol, Dublin, Ireland
Univ Coll Dublin, Mater Univ Hosp, Radiog & Diagnost Imaging, Sch Med, Dublin, Ireland
Marti-Fabregas, J:
Univ Autonoma Barcelona, Dept Neurol, Hosp Santa Creu & St Pau, Biomed Res Inst St Pau IIB St Pau, Barcelona, Spain
Murphy, S:
Univ Coll Dublin, Neurovasc Clin Sci Unit, Stroke Serv, Dublin, Ireland
Univ Coll Dublin, Dept Neurol, Dublin, Ireland
Univ Autonoma Barcelona, HRB Stroke Clin Trials Network Ireland, Barcelona, Spain
McNulty, J:
Univ Coll Dublin, Mater Univ Hosp, Radiog & Diagnost Imaging, Sch Med, Dublin, Ireland
Barry, M:
Univ Coll Dublin, St Vincents Univ Hosp, Dept Vasc Surg, Dublin, Ireland
Barry, P:
Cork Univ Hosp, Dept Geriatr Med, Stroke Serv, Cork, Ireland
Calvet, D:
Univ Paris 05, INSERM UMR S 894, Serv Neurol, Paris, France
Univ Paris 05, Unite Neurovasc, Hop St Anne, Paris, France
Coutts, SB:
Univ Calgary, Hotchkiss Brain Inst, Dept Clin Neurosci, Calgary, AB, Canada
Univ Calgary, Hotchkiss Brain Inst, Dept Radiol, Calgary, AB, Canada
Univ Calgary, Hotchkiss Brain Inst, Dept Community Hlth Sci, Calgary, AB, Canada
Cronin, S:
Univ Autonoma Barcelona, HRB Stroke Clin Trials Network Ireland, Barcelona, Spain
Univ Coll Cork, Coll Med & Hlth, Cork Univ Hosp, Dept Neurol, Cork, Ireland
Delgado-Mederos, R:
Univ Autonoma Barcelona, Dept Neurol, Hosp Santa Creu & St Pau, Biomed Res Inst St Pau IIB St Pau, Barcelona, Spain
Dolan, E:
Univ Autonoma Barcelona, HRB Stroke Clin Trials Network Ireland, Barcelona, Spain
Hosp Santa Creu & Sant Pau, Dept Nucl Med, Connolly Hosp Dublin, Barcelona, Spain
Fernandez-Leon, A:
Hosp Santa Creu & Sant Pau, Dept Nucl Med, Barcelona, Spain
Foley, S:
Univ Coll Dublin, Mater Univ Hosp, Radiog & Diagnost Imaging, Sch Med, Dublin, Ireland
Harbison, J:
Univ Autonoma Barcelona, HRB Stroke Clin Trials Network Ireland, Barcelona, Spain
St James Hosp, Dept Geriatr Med, Stroke Serv, Dublin, Ireland
Trinity Coll Dublin, Dublin, Ireland
Horgan, G:
Univ Coll Dublin, Neurovasc Clin Sci Unit, Stroke Serv, Dublin, Ireland
Univ Coll Dublin, Dept Neurol, Dublin, Ireland
Univ Autonoma Barcelona, HRB Stroke Clin Trials Network Ireland, Barcelona, Spain
Kavanagh, E:
Univ Coll Dublin, Dept Radiol, Dublin, Ireland
Marnane, M:
Univ Coll Dublin, Neurovasc Clin Sci Unit, Stroke Serv, Dublin, Ireland
Univ Coll Dublin, Dept Neurol, Dublin, Ireland
Univ Autonoma Barcelona, HRB Stroke Clin Trials Network Ireland, Barcelona, Spain
McDonnell, C:
Univ Coll Dublin, Dept Vasc Surg, Dublin, Ireland
O'Donohoe, M:
Univ Coll Dublin, Dept Vasc Surg, Dublin, Ireland
Sharma, V:
Natl Univ Singapore, Natl Univ Hlth Syst, Div Neurol, Singapore, Singapore
Natl Univ Singapore, Yong Loo Lin Sch Med, Singapore, Singapore
Walsh, C:
Univ Limerick, Hlth Res Inst, Limerick, Ireland
Univ Limerick, Dept Biostat, Limerick, Ireland
Williams, D:
Univ Autonoma Barcelona, HRB Stroke Clin Trials Network Ireland, Barcelona, Spain
Beaumont Hosp Dublin Ireland, Royal Coll Surg Ireland, Dept Geriatr & Stroke Med, Dublin, Ireland
O'Connell, M:
Univ Coll Dublin, Dept Radiol, Dublin, Ireland
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