The carotid tissue, a shelf-like lesion along the posterior wall of the internal carotid artery bulb, is associated with an increased risk of recurrent stroke within 2 years of the index stroke, which the study suggests that such patients may need more intensive secondary preventive measures Results published in JAMA Neurology.
Previous studies showed that 9 to 37% of patients under 60 years of age with cryptogenic stroke have symptomatic carotid tissues and that this carotid bulging is associated with a 10 to 20-fold increased risk of stroke recurrence, but high quality data are lacking.
The aim of the current study was to determine the 2-year risk of recurrent stroke in patients with symptomatic carotid tissue.
Using data from the MR CLEAN study (from 2010 to 2014) and the MR CLEAN registry (from 2014 to 2017), nationwide prospective multicenter studies on endovascular treatment, the study researchers identified 3439 consecutive patients with a stroke with major vascular occlusion. The presence of carotid tissue ipsilateral to the index line was determined by 2 neuroradiologists who reevaluated CT angiography images.
A total of 30 patients had a carotid mesh ipsilateral to the index stroke. The study researchers compared these patients to 168 patients without a carotid artery enrolled in the MR CLEAN follow-up study.
The primary endpoint was recurrent stroke within 2 years of the index stroke, comparing rates for patients with and without a carotid mesh.
Compared to patients without a carotid mesh, patients with a carotid mesh were younger (mean age 57 years vs. 66 years; P = 0.01) and were more likely to be women (women, 73% and 40%; P = .001).
Most of the patients (28 of 30 patients; 93%) received medical treatment after the index stroke, 23 of them with antiplatelet drugs and 5 with anticoagulant therapy.
During a follow-up period of 2 years, 5 of 30 patients (17%) with carotid tissue had a recurrent stroke, compared with 5 of 168 patients (3%) without carotid tissue (adjusted hazard ratio 4.9). ; 95% CI, 1.4-18.1).
The type and location of the recurrent stroke were determined in 4 of 5 patients with carotid tissue, and all 4 cases were in the same vascular area as the carotid tissue.
Restricting the analysis to patients with recurrent ischemic stroke ipsilateral to the index stroke showed an 8-fold increased risk of recurrent strokes in patients with ipsilateral carotid tissue compared to patients without carotid tissue (adjusted hazard ratio 8.1; 95% CI 1.4 .). -46.8)).
The study had several limitations, including a lack of follow-up data, the lack of standardized secondary measures, a limited number of patients with a carotid mesh, and differences between study populations in the two included studies.
“Our data suggest that medical treatment alone may not provide adequate protection against recurrent stroke. Prospective studies of targeted secondary prevention measures in patients with a CW [carotid web] are justified, ”concluded the study researchers.
Disclosure: Some study authors stated links with biotech, pharmaceutical, and / or device companies. For a full list of the author’s disclosures, see the original reference.
Guglielmi V., Compagne KCJ, Sarrami AH, et al. Assessment of recurrent stroke risk in patients with a carotid mesh. JAMA Neurol. Published online 10 May 2021. doi: 10.1001 / jamaneurol.2021.1101