Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

Andrew N. Nicolaides, Stavros K Kakkos, Efthyvoulos Kyriacou, Maura Griffin, Michael Sabetai, Dafydd J. Thomas, Thomas Tegos, George Geroulakos, Nicos Labropoulos, Caroline J. Dor, Tim P. Morris, Ross Naylor, Anne L. Abbott, R. Adovasio, B. Ziani, F. P. Alò, C. G. Cicilioni, Giuseppe Ambrosio, A. Andreev, G. M. Andreozzi & 132 others F. Verlato, G. Camporese, E. Arosio, E. Barkauskas, A. A.B. Barros D'Sa, P. Brannigan, V. Batchvarova, A. Dramov, P. Belardi, GP Novelli, G. Simoni, P. Bell, G. M. Biasi, P. Mingazzini, Natan M Bornstein, David Bouchier-Hayes, P. Fitzgerald, M. A. Cairols, P. G. Cao, P. DeRango, G. P. Carboni, C. Geoffredo, M. Catalano, B. Chambers, M. Goetzmann, A. Dickinson, N D Clement, M. Bobelyn, S. Coccheri, E. Conti, E. Diamantopoulos, E. A. Andreadis, P. B. Dimakakos, T. Kotsis, B. Eikelboom, L. Entz, Ferrari-Bardile, T. Aloi, M. Salerno, J. Fernandes e Fernandes, L. Pedro, D. E. Fitzgerald, Anne O'Shaunnersy, J. Fletcher, Sandro Forconi, R. Cappeli, M. Bicchi, S. Arrigucci, V Gallai, G. Cardaiolli, George Geroulakos, Stavros K Kakkos, L. F. Gomez-Isaza, G. Gorgoyannis, N. Liasis, M. Graf, P. Guarini, S. Hardy, P. Harris, Stuart Mark Aston, G. Iosa, A. Katsamouris, A. Giannoukas, M. Krzanowski, Andreas G. Ladurner, J. Leal-Monedero, B. B. Lee, C. Liapis, P. Galanis, W. Liboni, E. Pavanelli, E. Mannarino, G. Vaudo, P. McCollum, R. Levison, Giuseppe Micieli, D. Bosone, L. Middleton, M. Pantziaris, T. Tyllis, E. Minar, A. Willfort, L. Moggi, G. Nenci, S. Radicchia, A. N. Nicolaides, D. Thomas, L. Norgren, E. Ribbe, S. Novo, R. Tantillo, D. Olinic, W. Paaske, A. Pagnan, P. Pauletto, V. Pagliara, G. Pettina, C. Pratesi, S. Matticari, J. Polivka, P. Sevcik, P. Poredos, A. Blinc, V. Videcnik, A. Pujia, Albert Raso, P. Rispoli, M. Conforti, T. Robinson, M. S.J. Dennis, S. Rosfors, G. Rudofsky, Timm Schroeder, M. L. Gronholdt, G. Simoni, C. Finocchi, Raul Gonzalez Rodriguez, C. Spartera, Manuela Ventura, P. Scarpelli, M. Sprynger, B. Sadzot, C. Hottermans, Gustave Moonen, P. R. Taylor, A. Tovar-Pardo, J. Negreira, M. Vayssairat, J. M. Faintuch, J. Valaikiené, M. G. Walker, A. R. Wilkinson

Research output: Contribution to journalArticleResearchpeer-review

200 Citations (Scopus)

Abstract

Background The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis. Methods This was a prospective, multicenter, cohort study of patients undergoing medical intervention for vascular disease. Hazard ratios for ICA stenosis, clinical features, and plaque texture features associated with ipsilateral cerebrovascular or retinal ischemic (CORI) events were calculated using proportional hazards models. Results A total of 1121 patients with 50% to 99% asymptomatic ICA stenosis in relation to the bulb (European Carotid Surgery Trial [ECST] method) were followed-up for 6 to 96 months (mean, 48). A total of 130 ipsilateral CORI events occurred. Severity of stenosis, age, systolic blood pressure, increased serum creatinine, smoking history of more than 10 pack-years, history of contralateral transient ischemic attacks (TIAs) or stroke, low grayscale median (GSM), increased plaque area, plaque types 1, 2, and 3, and the presence of discrete white areas (DWAs) without acoustic shadowing were associated with increased risk. Receiver operating characteristic (ROC) curves were constructed for predicted risk versus observed CORI events as a measure of model validity. The areas under the ROC curves for a model of stenosis alone, a model of stenosis combined with clinical features and a model of stenosis combined with clinical, and plaque features were 0.59 (95% confidence interval [CI] 0.54-0.64), 0.66 (0.62-0.72), and 0.82 (0.78-0.86), respectively. In the last model, stenosis, history of contralateral TIAs or stroke, GSM, plaque area, and DWAs were independent predictors of ipsilateral CORI events. Combinations of these could stratify patients into different levels of risk for ipsilateral CORI and stroke, with predicted risk close to observed risk. Of the 923 patients with <70% stenosis, the predicted cumulative 5-year stroke rate was <5% in 495, 5% to 9.9% in 202, 10% to 19.9% in 142, and <20% in 84 patients. Conclusion Cerebrovascular risk stratification is possible using a combination of clinical and ultrasonic plaque features. These findings need to be validated in additional prospective studies of patients receiving optimal medical intervention alone.

Original languageEnglish
JournalJournal of Vascular Surgery
Volume52
Issue number6
DOIs
Publication statusPublished - Dec 2010
Externally publishedYes

Cite this

Nicolaides, A. N., Kakkos, S. K., Kyriacou, E., Griffin, M., Sabetai, M., Thomas, D. J., ... Wilkinson, A. R. (2010). Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification. Journal of Vascular Surgery, 52(6). https://doi.org/10.1016/j.jvs.2010.07.021
Nicolaides, Andrew N. ; Kakkos, Stavros K ; Kyriacou, Efthyvoulos ; Griffin, Maura ; Sabetai, Michael ; Thomas, Dafydd J. ; Tegos, Thomas ; Geroulakos, George ; Labropoulos, Nicos ; Dor, Caroline J. ; Morris, Tim P. ; Naylor, Ross ; Abbott, Anne L. ; Adovasio, R. ; Ziani, B. ; Alò, F. P. ; Cicilioni, C. G. ; Ambrosio, Giuseppe ; Andreev, A. ; Andreozzi, G. M. ; Verlato, F. ; Camporese, G. ; Arosio, E. ; Barkauskas, E. ; Barros D'Sa, A. A.B. ; Brannigan, P. ; Batchvarova, V. ; Dramov, A. ; Belardi, P. ; Novelli, GP ; Simoni, G. ; Bell, P. ; Biasi, G. M. ; Mingazzini, P. ; Bornstein, Natan M ; Bouchier-Hayes, David ; Fitzgerald, P. ; Cairols, M. A. ; Cao, P. G. ; DeRango, P. ; Carboni, G. P. ; Geoffredo, C. ; Catalano, M. ; Chambers, B. ; Goetzmann, M. ; Dickinson, A. ; Clement, N D ; Bobelyn, M. ; Coccheri, S. ; Conti, E. ; Diamantopoulos, E. ; Andreadis, E. A. ; Dimakakos, P. B. ; Kotsis, T. ; Eikelboom, B. ; Entz, L. ; Ferrari-Bardile ; Aloi, T. ; Salerno, M. ; Fernandes e Fernandes, J. ; Pedro, L. ; Fitzgerald, D. E. ; O'Shaunnersy, Anne ; Fletcher, J. ; Forconi, Sandro ; Cappeli, R. ; Bicchi, M. ; Arrigucci, S. ; Gallai, V ; Cardaiolli, G. ; Geroulakos, George ; Kakkos, Stavros K ; Gomez-Isaza, L. F. ; Gorgoyannis, G. ; Liasis, N. ; Graf, M. ; Guarini, P. ; Hardy, S. ; Harris, P. ; Aston, Stuart Mark ; Iosa, G. ; Katsamouris, A. ; Giannoukas, A. ; Krzanowski, M. ; Ladurner, Andreas G. ; Leal-Monedero, J. ; Lee, B. B. ; Liapis, C. ; Galanis, P. ; Liboni, W. ; Pavanelli, E. ; Mannarino, E. ; Vaudo, G. ; McCollum, P. ; Levison, R. ; Micieli, Giuseppe ; Bosone, D. ; Middleton, L. ; Pantziaris, M. ; Tyllis, T. ; Minar, E. ; Willfort, A. ; Moggi, L. ; Nenci, G. ; Radicchia, S. ; Nicolaides, A. N. ; Thomas, D. ; Norgren, L. ; Ribbe, E. ; Novo, S. ; Tantillo, R. ; Olinic, D. ; Paaske, W. ; Pagnan, A. ; Pauletto, P. ; Pagliara, V. ; Pettina, G. ; Pratesi, C. ; Matticari, S. ; Polivka, J. ; Sevcik, P. ; Poredos, P. ; Blinc, A. ; Videcnik, V. ; Pujia, A. ; Raso, Albert ; Rispoli, P. ; Conforti, M. ; Robinson, T. ; Dennis, M. S.J. ; Rosfors, S. ; Rudofsky, G. ; Schroeder, Timm ; Gronholdt, M. L. ; Simoni, G. ; Finocchi, C. ; Rodriguez, Raul Gonzalez ; Spartera, C. ; Ventura, Manuela ; Scarpelli, P. ; Sprynger, M. ; Sadzot, B. ; Hottermans, C. ; Moonen, Gustave ; Taylor, P. R. ; Tovar-Pardo, A. ; Negreira, J. ; Vayssairat, M. ; Faintuch, J. M. ; Valaikiené, J. ; Walker, M. G. ; Wilkinson, A. R. / Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification. In: Journal of Vascular Surgery. 2010 ; Vol. 52, No. 6.
@article{b92bc754613d438991548f39a6eec486,
title = "Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification",
abstract = "Background The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis. Methods This was a prospective, multicenter, cohort study of patients undergoing medical intervention for vascular disease. Hazard ratios for ICA stenosis, clinical features, and plaque texture features associated with ipsilateral cerebrovascular or retinal ischemic (CORI) events were calculated using proportional hazards models. Results A total of 1121 patients with 50{\%} to 99{\%} asymptomatic ICA stenosis in relation to the bulb (European Carotid Surgery Trial [ECST] method) were followed-up for 6 to 96 months (mean, 48). A total of 130 ipsilateral CORI events occurred. Severity of stenosis, age, systolic blood pressure, increased serum creatinine, smoking history of more than 10 pack-years, history of contralateral transient ischemic attacks (TIAs) or stroke, low grayscale median (GSM), increased plaque area, plaque types 1, 2, and 3, and the presence of discrete white areas (DWAs) without acoustic shadowing were associated with increased risk. Receiver operating characteristic (ROC) curves were constructed for predicted risk versus observed CORI events as a measure of model validity. The areas under the ROC curves for a model of stenosis alone, a model of stenosis combined with clinical features and a model of stenosis combined with clinical, and plaque features were 0.59 (95{\%} confidence interval [CI] 0.54-0.64), 0.66 (0.62-0.72), and 0.82 (0.78-0.86), respectively. In the last model, stenosis, history of contralateral TIAs or stroke, GSM, plaque area, and DWAs were independent predictors of ipsilateral CORI events. Combinations of these could stratify patients into different levels of risk for ipsilateral CORI and stroke, with predicted risk close to observed risk. Of the 923 patients with <70{\%} stenosis, the predicted cumulative 5-year stroke rate was <5{\%} in 495, 5{\%} to 9.9{\%} in 202, 10{\%} to 19.9{\%} in 142, and <20{\%} in 84 patients. Conclusion Cerebrovascular risk stratification is possible using a combination of clinical and ultrasonic plaque features. These findings need to be validated in additional prospective studies of patients receiving optimal medical intervention alone.",
author = "Nicolaides, {Andrew N.} and Kakkos, {Stavros K} and Efthyvoulos Kyriacou and Maura Griffin and Michael Sabetai and Thomas, {Dafydd J.} and Thomas Tegos and George Geroulakos and Nicos Labropoulos and Dor, {Caroline J.} and Morris, {Tim P.} and Ross Naylor and Abbott, {Anne L.} and R. Adovasio and B. Ziani and Al{\`o}, {F. P.} and Cicilioni, {C. G.} and Giuseppe Ambrosio and A. Andreev and Andreozzi, {G. M.} and F. Verlato and G. Camporese and E. Arosio and E. Barkauskas and {Barros D'Sa}, {A. A.B.} and P. Brannigan and V. Batchvarova and A. Dramov and P. Belardi and GP Novelli and G. Simoni and P. Bell and Biasi, {G. M.} and P. Mingazzini and Bornstein, {Natan M} and David Bouchier-Hayes and P. Fitzgerald and Cairols, {M. A.} and Cao, {P. G.} and P. DeRango and Carboni, {G. P.} and C. Geoffredo and M. Catalano and B. Chambers and M. Goetzmann and A. Dickinson and Clement, {N D} and M. Bobelyn and S. Coccheri and E. Conti and E. Diamantopoulos and Andreadis, {E. A.} and Dimakakos, {P. B.} and T. Kotsis and B. Eikelboom and L. Entz and Ferrari-Bardile and T. Aloi and M. Salerno and {Fernandes e Fernandes}, J. and L. Pedro and Fitzgerald, {D. E.} and Anne O'Shaunnersy and J. Fletcher and Sandro Forconi and R. Cappeli and M. Bicchi and S. Arrigucci and V Gallai and G. Cardaiolli and George Geroulakos and Kakkos, {Stavros K} and Gomez-Isaza, {L. F.} and G. Gorgoyannis and N. Liasis and M. Graf and P. Guarini and S. Hardy and P. Harris and Aston, {Stuart Mark} and G. Iosa and A. Katsamouris and A. Giannoukas and M. Krzanowski and Ladurner, {Andreas G.} and J. Leal-Monedero and Lee, {B. B.} and C. Liapis and P. Galanis and W. Liboni and E. Pavanelli and E. Mannarino and G. Vaudo and P. McCollum and R. Levison and Giuseppe Micieli and D. Bosone and L. Middleton and M. Pantziaris and T. Tyllis and E. Minar and A. Willfort and L. Moggi and G. Nenci and S. Radicchia and Nicolaides, {A. N.} and D. Thomas and L. Norgren and E. Ribbe and S. Novo and R. Tantillo and D. Olinic and W. Paaske and A. Pagnan and P. Pauletto and V. Pagliara and G. Pettina and C. Pratesi and S. Matticari and J. Polivka and P. Sevcik and P. Poredos and A. Blinc and V. Videcnik and A. Pujia and Albert Raso and P. Rispoli and M. Conforti and T. Robinson and Dennis, {M. S.J.} and S. Rosfors and G. Rudofsky and Timm Schroeder and Gronholdt, {M. L.} and G. Simoni and C. Finocchi and Rodriguez, {Raul Gonzalez} and C. Spartera and Manuela Ventura and P. Scarpelli and M. Sprynger and B. Sadzot and C. Hottermans and Gustave Moonen and Taylor, {P. R.} and A. Tovar-Pardo and J. Negreira and M. Vayssairat and Faintuch, {J. M.} and J. Valaikien{\'e} and Walker, {M. G.} and Wilkinson, {A. R.}",
year = "2010",
month = "12",
doi = "10.1016/j.jvs.2010.07.021",
language = "English",
volume = "52",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Elsevier",
number = "6",

}

Nicolaides, AN, Kakkos, SK, Kyriacou, E, Griffin, M, Sabetai, M, Thomas, DJ, Tegos, T, Geroulakos, G, Labropoulos, N, Dor, CJ, Morris, TP, Naylor, R, Abbott, AL, Adovasio, R, Ziani, B, Alò, FP, Cicilioni, CG, Ambrosio, G, Andreev, A, Andreozzi, GM, Verlato, F, Camporese, G, Arosio, E, Barkauskas, E, Barros D'Sa, AAB, Brannigan, P, Batchvarova, V, Dramov, A, Belardi, P, Novelli, GP, Simoni, G, Bell, P, Biasi, GM, Mingazzini, P, Bornstein, NM, Bouchier-Hayes, D, Fitzgerald, P, Cairols, MA, Cao, PG, DeRango, P, Carboni, GP, Geoffredo, C, Catalano, M, Chambers, B, Goetzmann, M, Dickinson, A, Clement, ND, Bobelyn, M, Coccheri, S, Conti, E, Diamantopoulos, E, Andreadis, EA, Dimakakos, PB, Kotsis, T, Eikelboom, B, Entz, L, Ferrari-Bardile, Aloi, T, Salerno, M, Fernandes e Fernandes, J, Pedro, L, Fitzgerald, DE, O'Shaunnersy, A, Fletcher, J, Forconi, S, Cappeli, R, Bicchi, M, Arrigucci, S, Gallai, V, Cardaiolli, G, Geroulakos, G, Kakkos, SK, Gomez-Isaza, LF, Gorgoyannis, G, Liasis, N, Graf, M, Guarini, P, Hardy, S, Harris, P, Aston, SM, Iosa, G, Katsamouris, A, Giannoukas, A, Krzanowski, M, Ladurner, AG, Leal-Monedero, J, Lee, BB, Liapis, C, Galanis, P, Liboni, W, Pavanelli, E, Mannarino, E, Vaudo, G, McCollum, P, Levison, R, Micieli, G, Bosone, D, Middleton, L, Pantziaris, M, Tyllis, T, Minar, E, Willfort, A, Moggi, L, Nenci, G, Radicchia, S, Nicolaides, AN, Thomas, D, Norgren, L, Ribbe, E, Novo, S, Tantillo, R, Olinic, D, Paaske, W, Pagnan, A, Pauletto, P, Pagliara, V, Pettina, G, Pratesi, C, Matticari, S, Polivka, J, Sevcik, P, Poredos, P, Blinc, A, Videcnik, V, Pujia, A, Raso, A, Rispoli, P, Conforti, M, Robinson, T, Dennis, MSJ, Rosfors, S, Rudofsky, G, Schroeder, T, Gronholdt, ML, Simoni, G, Finocchi, C, Rodriguez, RG, Spartera, C, Ventura, M, Scarpelli, P, Sprynger, M, Sadzot, B, Hottermans, C, Moonen, G, Taylor, PR, Tovar-Pardo, A, Negreira, J, Vayssairat, M, Faintuch, JM, Valaikiené, J, Walker, MG & Wilkinson, AR 2010, 'Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification', Journal of Vascular Surgery, vol. 52, no. 6. https://doi.org/10.1016/j.jvs.2010.07.021

Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification. / Nicolaides, Andrew N.; Kakkos, Stavros K; Kyriacou, Efthyvoulos; Griffin, Maura; Sabetai, Michael; Thomas, Dafydd J.; Tegos, Thomas; Geroulakos, George; Labropoulos, Nicos; Dor, Caroline J.; Morris, Tim P.; Naylor, Ross; Abbott, Anne L.; Adovasio, R.; Ziani, B.; Alò, F. P.; Cicilioni, C. G.; Ambrosio, Giuseppe; Andreev, A.; Andreozzi, G. M.; Verlato, F.; Camporese, G.; Arosio, E.; Barkauskas, E.; Barros D'Sa, A. A.B.; Brannigan, P.; Batchvarova, V.; Dramov, A.; Belardi, P.; Novelli, GP; Simoni, G.; Bell, P.; Biasi, G. M.; Mingazzini, P.; Bornstein, Natan M; Bouchier-Hayes, David; Fitzgerald, P.; Cairols, M. A.; Cao, P. G.; DeRango, P.; Carboni, G. P.; Geoffredo, C.; Catalano, M.; Chambers, B.; Goetzmann, M.; Dickinson, A.; Clement, N D; Bobelyn, M.; Coccheri, S.; Conti, E.; Diamantopoulos, E.; Andreadis, E. A.; Dimakakos, P. B.; Kotsis, T.; Eikelboom, B.; Entz, L.; Ferrari-Bardile; Aloi, T.; Salerno, M.; Fernandes e Fernandes, J.; Pedro, L.; Fitzgerald, D. E.; O'Shaunnersy, Anne; Fletcher, J.; Forconi, Sandro; Cappeli, R.; Bicchi, M.; Arrigucci, S.; Gallai, V; Cardaiolli, G.; Geroulakos, George; Kakkos, Stavros K; Gomez-Isaza, L. F.; Gorgoyannis, G.; Liasis, N.; Graf, M.; Guarini, P.; Hardy, S.; Harris, P.; Aston, Stuart Mark; Iosa, G.; Katsamouris, A.; Giannoukas, A.; Krzanowski, M.; Ladurner, Andreas G.; Leal-Monedero, J.; Lee, B. B.; Liapis, C.; Galanis, P.; Liboni, W.; Pavanelli, E.; Mannarino, E.; Vaudo, G.; McCollum, P.; Levison, R.; Micieli, Giuseppe; Bosone, D.; Middleton, L.; Pantziaris, M.; Tyllis, T.; Minar, E.; Willfort, A.; Moggi, L.; Nenci, G.; Radicchia, S.; Nicolaides, A. N.; Thomas, D.; Norgren, L.; Ribbe, E.; Novo, S.; Tantillo, R.; Olinic, D.; Paaske, W.; Pagnan, A.; Pauletto, P.; Pagliara, V.; Pettina, G.; Pratesi, C.; Matticari, S.; Polivka, J.; Sevcik, P.; Poredos, P.; Blinc, A.; Videcnik, V.; Pujia, A.; Raso, Albert; Rispoli, P.; Conforti, M.; Robinson, T.; Dennis, M. S.J.; Rosfors, S.; Rudofsky, G.; Schroeder, Timm; Gronholdt, M. L.; Simoni, G.; Finocchi, C.; Rodriguez, Raul Gonzalez; Spartera, C.; Ventura, Manuela; Scarpelli, P.; Sprynger, M.; Sadzot, B.; Hottermans, C.; Moonen, Gustave; Taylor, P. R.; Tovar-Pardo, A.; Negreira, J.; Vayssairat, M.; Faintuch, J. M.; Valaikiené, J.; Walker, M. G.; Wilkinson, A. R.

In: Journal of Vascular Surgery, Vol. 52, No. 6, 12.2010.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

AU - Nicolaides, Andrew N.

AU - Kakkos, Stavros K

AU - Kyriacou, Efthyvoulos

AU - Griffin, Maura

AU - Sabetai, Michael

AU - Thomas, Dafydd J.

AU - Tegos, Thomas

AU - Geroulakos, George

AU - Labropoulos, Nicos

AU - Dor, Caroline J.

AU - Morris, Tim P.

AU - Naylor, Ross

AU - Abbott, Anne L.

AU - Adovasio, R.

AU - Ziani, B.

AU - Alò, F. P.

AU - Cicilioni, C. G.

AU - Ambrosio, Giuseppe

AU - Andreev, A.

AU - Andreozzi, G. M.

AU - Verlato, F.

AU - Camporese, G.

AU - Arosio, E.

AU - Barkauskas, E.

AU - Barros D'Sa, A. A.B.

AU - Brannigan, P.

AU - Batchvarova, V.

AU - Dramov, A.

AU - Belardi, P.

AU - Novelli, GP

AU - Simoni, G.

AU - Bell, P.

AU - Biasi, G. M.

AU - Mingazzini, P.

AU - Bornstein, Natan M

AU - Bouchier-Hayes, David

AU - Fitzgerald, P.

AU - Cairols, M. A.

AU - Cao, P. G.

AU - DeRango, P.

AU - Carboni, G. P.

AU - Geoffredo, C.

AU - Catalano, M.

AU - Chambers, B.

AU - Goetzmann, M.

AU - Dickinson, A.

AU - Clement, N D

AU - Bobelyn, M.

AU - Coccheri, S.

AU - Conti, E.

AU - Diamantopoulos, E.

AU - Andreadis, E. A.

AU - Dimakakos, P. B.

AU - Kotsis, T.

AU - Eikelboom, B.

AU - Entz, L.

AU - Ferrari-Bardile, null

AU - Aloi, T.

AU - Salerno, M.

AU - Fernandes e Fernandes, J.

AU - Pedro, L.

AU - Fitzgerald, D. E.

AU - O'Shaunnersy, Anne

AU - Fletcher, J.

AU - Forconi, Sandro

AU - Cappeli, R.

AU - Bicchi, M.

AU - Arrigucci, S.

AU - Gallai, V

AU - Cardaiolli, G.

AU - Geroulakos, George

AU - Kakkos, Stavros K

AU - Gomez-Isaza, L. F.

AU - Gorgoyannis, G.

AU - Liasis, N.

AU - Graf, M.

AU - Guarini, P.

AU - Hardy, S.

AU - Harris, P.

AU - Aston, Stuart Mark

AU - Iosa, G.

AU - Katsamouris, A.

AU - Giannoukas, A.

AU - Krzanowski, M.

AU - Ladurner, Andreas G.

AU - Leal-Monedero, J.

AU - Lee, B. B.

AU - Liapis, C.

AU - Galanis, P.

AU - Liboni, W.

AU - Pavanelli, E.

AU - Mannarino, E.

AU - Vaudo, G.

AU - McCollum, P.

AU - Levison, R.

AU - Micieli, Giuseppe

AU - Bosone, D.

AU - Middleton, L.

AU - Pantziaris, M.

AU - Tyllis, T.

AU - Minar, E.

AU - Willfort, A.

AU - Moggi, L.

AU - Nenci, G.

AU - Radicchia, S.

AU - Nicolaides, A. N.

AU - Thomas, D.

AU - Norgren, L.

AU - Ribbe, E.

AU - Novo, S.

AU - Tantillo, R.

AU - Olinic, D.

AU - Paaske, W.

AU - Pagnan, A.

AU - Pauletto, P.

AU - Pagliara, V.

AU - Pettina, G.

AU - Pratesi, C.

AU - Matticari, S.

AU - Polivka, J.

AU - Sevcik, P.

AU - Poredos, P.

AU - Blinc, A.

AU - Videcnik, V.

AU - Pujia, A.

AU - Raso, Albert

AU - Rispoli, P.

AU - Conforti, M.

AU - Robinson, T.

AU - Dennis, M. S.J.

AU - Rosfors, S.

AU - Rudofsky, G.

AU - Schroeder, Timm

AU - Gronholdt, M. L.

AU - Simoni, G.

AU - Finocchi, C.

AU - Rodriguez, Raul Gonzalez

AU - Spartera, C.

AU - Ventura, Manuela

AU - Scarpelli, P.

AU - Sprynger, M.

AU - Sadzot, B.

AU - Hottermans, C.

AU - Moonen, Gustave

AU - Taylor, P. R.

AU - Tovar-Pardo, A.

AU - Negreira, J.

AU - Vayssairat, M.

AU - Faintuch, J. M.

AU - Valaikiené, J.

AU - Walker, M. G.

AU - Wilkinson, A. R.

PY - 2010/12

Y1 - 2010/12

N2 - Background The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis. Methods This was a prospective, multicenter, cohort study of patients undergoing medical intervention for vascular disease. Hazard ratios for ICA stenosis, clinical features, and plaque texture features associated with ipsilateral cerebrovascular or retinal ischemic (CORI) events were calculated using proportional hazards models. Results A total of 1121 patients with 50% to 99% asymptomatic ICA stenosis in relation to the bulb (European Carotid Surgery Trial [ECST] method) were followed-up for 6 to 96 months (mean, 48). A total of 130 ipsilateral CORI events occurred. Severity of stenosis, age, systolic blood pressure, increased serum creatinine, smoking history of more than 10 pack-years, history of contralateral transient ischemic attacks (TIAs) or stroke, low grayscale median (GSM), increased plaque area, plaque types 1, 2, and 3, and the presence of discrete white areas (DWAs) without acoustic shadowing were associated with increased risk. Receiver operating characteristic (ROC) curves were constructed for predicted risk versus observed CORI events as a measure of model validity. The areas under the ROC curves for a model of stenosis alone, a model of stenosis combined with clinical features and a model of stenosis combined with clinical, and plaque features were 0.59 (95% confidence interval [CI] 0.54-0.64), 0.66 (0.62-0.72), and 0.82 (0.78-0.86), respectively. In the last model, stenosis, history of contralateral TIAs or stroke, GSM, plaque area, and DWAs were independent predictors of ipsilateral CORI events. Combinations of these could stratify patients into different levels of risk for ipsilateral CORI and stroke, with predicted risk close to observed risk. Of the 923 patients with <70% stenosis, the predicted cumulative 5-year stroke rate was <5% in 495, 5% to 9.9% in 202, 10% to 19.9% in 142, and <20% in 84 patients. Conclusion Cerebrovascular risk stratification is possible using a combination of clinical and ultrasonic plaque features. These findings need to be validated in additional prospective studies of patients receiving optimal medical intervention alone.

AB - Background The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis. Methods This was a prospective, multicenter, cohort study of patients undergoing medical intervention for vascular disease. Hazard ratios for ICA stenosis, clinical features, and plaque texture features associated with ipsilateral cerebrovascular or retinal ischemic (CORI) events were calculated using proportional hazards models. Results A total of 1121 patients with 50% to 99% asymptomatic ICA stenosis in relation to the bulb (European Carotid Surgery Trial [ECST] method) were followed-up for 6 to 96 months (mean, 48). A total of 130 ipsilateral CORI events occurred. Severity of stenosis, age, systolic blood pressure, increased serum creatinine, smoking history of more than 10 pack-years, history of contralateral transient ischemic attacks (TIAs) or stroke, low grayscale median (GSM), increased plaque area, plaque types 1, 2, and 3, and the presence of discrete white areas (DWAs) without acoustic shadowing were associated with increased risk. Receiver operating characteristic (ROC) curves were constructed for predicted risk versus observed CORI events as a measure of model validity. The areas under the ROC curves for a model of stenosis alone, a model of stenosis combined with clinical features and a model of stenosis combined with clinical, and plaque features were 0.59 (95% confidence interval [CI] 0.54-0.64), 0.66 (0.62-0.72), and 0.82 (0.78-0.86), respectively. In the last model, stenosis, history of contralateral TIAs or stroke, GSM, plaque area, and DWAs were independent predictors of ipsilateral CORI events. Combinations of these could stratify patients into different levels of risk for ipsilateral CORI and stroke, with predicted risk close to observed risk. Of the 923 patients with <70% stenosis, the predicted cumulative 5-year stroke rate was <5% in 495, 5% to 9.9% in 202, 10% to 19.9% in 142, and <20% in 84 patients. Conclusion Cerebrovascular risk stratification is possible using a combination of clinical and ultrasonic plaque features. These findings need to be validated in additional prospective studies of patients receiving optimal medical intervention alone.

UR - http://www.scopus.com/inward/record.url?scp=84864739554&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2010.07.021

DO - 10.1016/j.jvs.2010.07.021

M3 - Article

VL - 52

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 6

ER -