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Open Access 18-12-2023 | Stroke | Original Article

Symptomatic Non-stenotic Carotid Disease in Embolic Stroke of Undetermined Source

Analysis of the ESCAPE-NA1 Trial

Authors: Martha Marko, Nishita Singh, Johanna M. Ospel, Kazutaka Uchida, Mohammed A. Almekhlafi, Andrew M. Demchuk, Raul G. Nogueira, Ryan A. McTaggart, Alexandre Y. Poppe, Jeremy L. Rempel, Michael Tymianski, Michael D. Hill, Mayank Goyal, Bijoy K. Menon, the ESCAPE-NA1 Investigators

Published in: Clinical Neuroradiology

Abstract

Purpose

Non-stenotic (< 50%) carotid disease may play an important etiological role in ischemic stroke classified as embolic stroke of undetermined source (ESUS). We aimed to assess the prevalence of non-stenotic carotid disease and its association with ipsilateral ischemic stroke.

Methods

Data are from ESCAPE-NA1, a randomized controlled trial investigating the neuroprotectant nerinetide in patients with acute ischemic stroke and large vessel occlusion (LVO). The degree of stenosis of the extracranial internal carotid artery (ICA) and high-risk plaque features were assessed on baseline computed tomography (CT) angiography. We evaluated the association of non-stenotic carotid disease and ipsilateral stroke by age-adjusted and sex-adjusted logistic regression and calculated the attributable risk of ipsilateral stroke caused by non-stenotic carotid disease.

Results

After excluding patients with non-assessable imaging, symptomatic > 50% carotid stenosis and extracranial dissection, 799/1105 (72.1%) patients enrolled in ESCAPE-NA1 remained for this analysis. Of these, 127 (15.9%) were classified as ESUS. Non-stenotic carotid disease occurred in 34/127 ESUS patients (26.8%) and was associated with the presence of ipsilateral ischemic stroke (odds ratio, OR 1.6, 95% confidence interval, CI 1.0–2.6, p = 0.049). The risk of ipsilateral ischemic stroke attributable to non-stenotic carotid disease in ESUS was estimated to be 19.7% (95% CI −5.7% to 39%), the population attributable risk was calculated as 4.3%. Imaging features such as plaque thickness, plaque irregularity or plaque ulceration were not different between non-stenotic carotids with vs. without ipsilateral stroke.

Conclusion

Non-stenotic carotid disease frequently occurs in patients classified as ESUS and is associated with ipsilateral ischemic stroke. Our findings support the role of non-stenotic carotid disease as stroke etiology in ESUS, but further prospective research is needed to prove a causal relationship.

Available only for authorised users

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Title: Symptomatic Non-stenotic Carotid Disease in Embolic Stroke of Undetermined Source
Analysis of the ESCAPE-NA1 Trial
Authors: Martha Marko
Nishita Singh
Johanna M. Ospel
Kazutaka Uchida
Mohammed A. Almekhlafi
Andrew M. Demchuk
Raul G. Nogueira
Ryan A. McTaggart
Alexandre Y. Poppe
Jeremy L. Rempel
Michael Tymianski
Michael D. Hill
Mayank Goyal
Bijoy K. Menon
the ESCAPE-NA1 Investigators
Publication date: 18-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Stroke
Carotid Stenosis
Carotid Stenosis
CT Angiography
Published in: Clinical Neuroradiology
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI: https://doi.org/10.1007/s00062-023-01365-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Symptomatic Non-stenotic Carotid Disease in Embolic Stroke of Undetermined Source

Analysis of the ESCAPE-NA1 Trial

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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