Study Examines Culprit of Non-Stenosing Plaque as the Cause of Ischemic Stroke

Some strokes from large-artery atherosclerosis may not be recognized due to plaque causing less than 50 percent stenosis, according to a study presented Feb. 17 at the International Stroke Conference and simultaneously published in JACC: Cardiovascular Imaging.

Ajay Gupta, MD, et al., looked at 109 patients in a prospective stroke registry, and assessed the association between non-stenosing, vulnerable large-artery plaque and ischemic stroke.

They found that 22 patients had less than 50 percent internal carotid artery (ICA) plaque with intraplaque high-intensity signal (IHIS) ipsilateral to the side of infarction, compared with nine patients who had IHIS in less than 50 percent ICA plaque contralateral to the side of infarction (P=0.01).  In addition, the median degree of vessel luminal narrowing was not significantly different on the ipsilateral vs. contralateral side of the infarction (P=0.67).

The authors conclude that moving forward, larger confirmatory prospective studies are needed to investigate stroke recurrence rates in IHIS positive patients. “Such studies are important because if patients who are currently labeled as cryptogenic stroke are more correctly identified as harboring a culprit large-artery atherosclerotic lesion, they may benefit from intensified and targeted therapy aimed at reducing the risk of recurrent stroke and other major adverse events,” they add. 

Clinical Topics: Vascular Medicine

Keywords: Atherosclerosis, Carotid Artery, Internal, Carotid Stenosis, Cerebral Infarction, Constriction, Pathologic, Infarction, Prospective Studies, Stroke

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