Clinical and Imaging Features Associated with an Increased Risk of Early and Late Stroke in Patients with Symptomatic Carotid Disease

• Published in: European journal of vascular and endovascular surgery 2015-05, Vol.49 (5), p.513-523
• Main Authors: Naylor, A.R, Sillesen, H, Schroeder, T.V
• Format: Article
• Language: English
• Subjects: Animals; Carotid stenosis; Carotid Stenosis - surgery; Endarterectomy; Endarterectomy, Carotid - methods; Humans; Risk Assessment; Risk Factors; Stroke; Stroke - surgery; Surgery; Transient ischaemic attack
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2015.01.011

Objective The aim of this review was to identify clinical and/or imaging parameters that are associated with an increased (decreased) risk of early/late stroke in patients with symptomatic carotid disease. In the first 14 days Natural history studies suggest that 8–15% of patients with 50–99% stenoses will suffer a stroke within 72 hours of their index symptom. Currently, there are insufficient validated data to identify highest-risk patients for emergency carotid endarterectomy (CEA), but an increased risk of stroke appears to be predicted by (i) an ABCD2 score of 4–7; (ii) the presence of acute cerebral injury on CT/MRI; (iii) Gray Scale Median (GSM) 75; (iii) hemispheric symptoms; and (iv) increasing comorbidity. Imaging features associated with increased stroke risk include (i) irregular stenoses; (ii) contralateral occlusion; (iii) increasing stenosis severity, but not subocclusion; (iv) tandem intracranial disease; (v) a failure to recruit intracranial collaterals; (vi) low GSM; (vii) MR diagnosis of intra-plaque haemorrhage; (vii) spontaneous embolisation on TCD; and (viii) increased FDG uptake in the carotid plaque on PET. Clinical/imaging parameters associated with a lower risk of stroke include (i) female gender, especially those with 50–99% stenoses; (ii) ocular symptoms/lacunar stroke; (iii) smooth stenoses; and (iv) chronic subocclusion.