Carotid Plaque Inflammation Imaged by PET and Prediction of Recurrent Stroke at 5 Years
Por:
McCabe, JJ, Camps-Renom, P, Giannotti, N, McNulty, JP, Coveney, S, Murphy, S, Barry, M, Harbison, J, Cronin, S, Williams, D, Horgan, G, Dolan, E, Cassidy, T, McDonnell, C, Kavanagh, E, Foley, S, Collins, S, O'Connell, M, Fernandez-Leon, A, Delgado-Mederos, R, Marnane, M, Marti-Fabregas, J, Kelly, PJ
Publicada:
7 dic 2021
Resumen:
Background and Objectives To determine whether carotid plaque inflammation identified by F-18-fluorodeoxyglucose ((18)FDG)-PET is associated with late (5-year) recurrent stroke. Methods We did an individual-participant data pooled analysis of 3 prospective studies with near-identical study methods. Eligible patients had recent nonsevere (modified Rankin Scale score <= 3) ischemic stroke/TIA and ipsilateral carotid stenosis (50%-99%). Participants underwent carotid (18)FDG-PET/CT angiography <= 14 days after recruitment. (18)FDG uptake was expressed as maximum standardized uptake value (SUVmax) in the axial single hottest slice of symptomatic plaque. We calculated the previously validated Symptomatic Carotid Atheroma Inflammation Lumen-Stenosis (SCAIL) score, which incorporates a measure of stenosis severity and (18)FDG uptake. The primary outcome was 5-year recurrent ipsilateral ischemic stroke after PET imaging. Results Of 183 eligible patients, 181 patients completed follow-up (98.9%). The median duration of follow-up was 4.9 years (interquartile range 3.3-6.4 years, cumulative follow-up period 901.8 patient-years). After PET imaging, 17 patients had a recurrent ipsilateral ischemic strokes at 5 years (recurrence rate 9.4%, 95% confidence interval [CI] 5.6%-14.6%). Baseline plaque SUVmax independently predicted 5-year ipsilateral recurrent stroke after adjustment for age, sex, carotid revascularization, stenosis severity, NIH Stroke Scale score, and diabetes mellitus (adjusted hazard ratio [HR] 1.98, 95% CI 1.10-3.56, p = 0.02 per 1-g/mL increase in SUVmax). On multivariable Cox regression, SCAIL score predicted 5-year ipsilateral stroke (adjusted HR 2.73 per 1-point increase, 95% CI 1.52-4.90, p = 0.001). Discussion Plaque inflammation-related (18)FDG uptake improved identification of 5-year recurrent ipsilateral ischemic stroke. Addition of plaque inflammation to current selection strategies may target patients most likely to have late and early benefit from carotid revascularization. Classification of Evidence This study provides Class I evidence that in individuals with recent ischemic stroke/TIA and ipsilateral carotid stenosis, carotid plaque inflammation-related (18)FDG uptake on PET/CT angiography was associated with 5-year recurrent ipsilateral stroke.
Filiaciones:
McCabe, JJ:
Stroke Clin Trials Network Ireland SCTNI, Hlth Res Board HRB, Dublin, Ireland
Univ Coll Dublin UCD, Sch Med, Dublin, Ireland
Camps-Renom, P:
Hosp Santa Creu & Sant Pau, Dept Neurol, Barcelona, Spain
Univ Autonoma Barcelona, Biomed Res Inst St Pau IIB St Pau, Barcelona, Spain
Giannotti, N:
Univ Coll Dublin UCD, Sch Med, Dublin, Ireland
McNulty, JP:
Univ Coll Dublin UCD, Sch Med, Dublin, Ireland
Coveney, S:
Stroke Clin Trials Network Ireland SCTNI, Hlth Res Board HRB, Dublin, Ireland
Murphy, S:
Stroke Clin Trials Network Ireland SCTNI, Hlth Res Board HRB, Dublin, Ireland
Univ Coll Dublin UCD, Sch Med, Dublin, Ireland
Barry, M:
St Vincents Univ Hosp, Dept Vasc Surg, Dublin, Ireland
Harbison, J:
Stroke Clin Trials Network Ireland SCTNI, Hlth Res Board HRB, Dublin, Ireland
St James Hosp, Dept Geriatr Med, Stroke Serv, Dublin, Ireland
Cronin, S:
Stroke Clin Trials Network Ireland SCTNI, Hlth Res Board HRB, Dublin, Ireland
Cork Univ Hosp, Dept Neurol, Cork, Ireland
Univ Coll Cork, Coll Med & Hlth, Dept Clin Neurosci, Cork, Ireland
Williams, D:
Stroke Clin Trials Network Ireland SCTNI, Hlth Res Board HRB, Dublin, Ireland
Univ Med & Hlth Sci, Royal Coll Surg Ireland, Dept Geriatr & Stroke Med, Dublin, Ireland
Horgan, G:
Stroke Clin Trials Network Ireland SCTNI, Hlth Res Board HRB, Dublin, Ireland
Dolan, E:
Stroke Clin Trials Network Ireland SCTNI, Hlth Res Board HRB, Dublin, Ireland
James Connolly Mem Hosp, Dept Geriatr Med, Dublin, Ireland
Cassidy, T:
Stroke Clin Trials Network Ireland SCTNI, Hlth Res Board HRB, Dublin, Ireland
St Vincents Univ Hosp, Dept Geriatr Med, Dublin, Ireland
McDonnell, C:
Mater Misericordiae Univ Hosp, Dept Vasc Surg, Dublin, Ireland
Kavanagh, E:
Mater Misericordiae Univ Hosp, Dept Radiol, Dublin, Ireland
Foley, S:
Univ Coll Dublin UCD, Sch Med, Dublin, Ireland
Collins, S:
Stroke Clin Trials Network Ireland SCTNI, Hlth Res Board HRB, Dublin, Ireland
O'Connell, M:
Mater Misericordiae Univ Hosp, Dept Radiol, Dublin, Ireland
Fernandez-Leon, A:
Hosp Santa Creu & Sant Pau, Dept Nucl Med, Barcelona, Spain
Delgado-Mederos, R:
Hosp Santa Creu & Sant Pau, Dept Neurol, Barcelona, Spain
Univ Autonoma Barcelona, Biomed Res Inst St Pau IIB St Pau, Barcelona, Spain
Marnane, M:
Stroke Clin Trials Network Ireland SCTNI, Hlth Res Board HRB, Dublin, Ireland
Univ Coll Dublin UCD, Sch Med, Dublin, Ireland
Marti-Fabregas, J:
Hosp Santa Creu & Sant Pau, Dept Neurol, Barcelona, Spain
Univ Autonoma Barcelona, Biomed Res Inst St Pau IIB St Pau, Barcelona, Spain
Kelly, PJ:
Stroke Clin Trials Network Ireland SCTNI, Hlth Res Board HRB, Dublin, Ireland
Univ Coll Dublin UCD, Sch Med, Dublin, Ireland
|