Contralateral Stenosis and Echolucent Plaque Morphology are Associated with Elevated Stroke Risk in Patients Treated with Asymptomatic Carotid Artery Stenosis within a Controlled Clinical Trial (SPACE-2).

Reiff, Tilman; Eckstein, Hans-Henning; Mansmann, Ulrich; Jansen, Olav; Fraedrich, Gustav; Mudra, Harald; Böckler, Dittmar; Böhm, Michael; Brückmann, Hartmut; Debus, E Sebastian; Fiehler, Jens; Mathias, Klaus; Ringelstein, E Bernd; Schmidli, Jürg; Stingele, Robert; Zahn, Ralf; Zeller, Thomas; Niesen, Wolf-Dirk; Barlinn, Kristian; Binder, Andreas; ... (2021). Contralateral Stenosis and Echolucent Plaque Morphology are Associated with Elevated Stroke Risk in Patients Treated with Asymptomatic Carotid Artery Stenosis within a Controlled Clinical Trial (SPACE-2). Journal of stroke and cerebrovascular diseases, 30(9), p. 105940. Elsevier 10.1016/j.jstrokecerebrovasdis.2021.105940

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BACKGROUND

Asymptomatic carotid artery stenosis (ACS) has a low risk of stroke. To achieve an advantage over noninterventional best medical treatment (BMT), carotid endarterectomy (CEA) or carotid artery stenting (CAS) must be performed with the lowest possible risk of stroke. Therefore, an analysis of risk-elevating factors is essential. Grade of ipsilateral and contralateral stenosis as well as plaque morphology are known risk factors in ACS.

METHODS

The randomized, controlled, multicenter SPACE-2 trial had to be stopped prematurely after recruiting 513 patients. 203 patients were randomized to CEA, 197 to CAS, and 113 to BMT. Within one year, risk factors such as grade of stenosis and plaque morphology were analyzed.

RESULTS

Grade of contralateral stenosis (GCS) was higher in patients with any stroke (50%ECST vs. 20%ECST; p=0.012). Echolucent plaque morphology was associated with any stroke on the day of intervention (OR 5.23; p=0.041). In the periprocedural period, any stroke was correlated with GCS in the CEA group (70%ECST vs. 20%ECST; p=0.026) and with echolucent plaque morphology in the CAS group (6% vs. 1%; p=0.048). In multivariate analysis, occlusion of the contralateral carotid artery (CCO) was associated with risk of any stroke (OR 7.00; p=0.006), without heterogeneity between CEA and CAS.

CONCLUSION

In patients with asymptomatic carotid artery stenosis, GCS, CCO, as well as echolucent plaque morphology were associated with a higher risk of cerebrovascular events. The risk of stroke in the periprocedural period was increased by GCS in CEA and by echolucent plaque in CAS. Due to small sample size, results must be interpreted carefully.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Schmidli, Jürg

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1532-8511

Publisher:

Elsevier

Language:

English

Submitter:

Paul Libera

Date Deposited:

13 Jan 2022 08:12

Last Modified:

16 Jan 2022 01:55

Publisher DOI:

10.1016/j.jstrokecerebrovasdis.2021.105940

PubMed ID:

34311420

Uncontrolled Keywords:

Asymptomatic carotid artery stenosis Best Medical Treatment Carotid Artery Stenting Carotid Endarterectomy Contralateral stenosis Echolucent Plaque

BORIS DOI:

10.48350/162652

URI:

https://boris.unibe.ch/id/eprint/162652

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