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).

Aged Asymptomatic Diseases Carotid Intima-Media Thickness Carotid Stenosis / complications Endarterectomy, Carotid / adverse effects Endovascular Procedures / adverse effects Europe Female Humans Male Middle Aged Plaque, Atherosclerotic Predictive Value of Tests Prospective Studies Risk Assessment Risk Factors Stents Stroke / diagnosis Time Factors Treatment Outcome

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

Journal

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

ISSN: 1532-8511

Titre abrégé: J Stroke Cerebrovasc Dis

Pays: United States

ID NLM: 9111633

Informations de publication

Date de publication:
Sep 2021

Historique:

received: 25 03 2021

revised: 30 05 2021

accepted: 01 06 2021

pubmed: 27 7 2021

medline: 31 8 2021

entrez: 26 7 2021

Statut: ppublish

Résumé

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. 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. Grade of contralateral stenosis (GCS) was higher in patients with any stroke (50% 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.

Sections du résumé

BACKGROUND BACKGROUND

METHODS 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 RESULTS

Grade of contralateral stenosis (GCS) was higher in patients with any stroke (50%

CONCLUSION CONCLUSIONS

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.

Identifiants

DOI: 10.1016/j.jstrokecerebrovasdis.2021.105940 PMID: 34311420

pubmed: 34311420

pii: S1052-3057(21)00343-8

doi: 10.1016/j.jstrokecerebrovasdis.2021.105940

pii:

doi:

Types de publication

Comparative Study Journal Article Multicenter Study Randomized Controlled Trial

Langues

eng

Sous-ensembles de citation

Pagination

105940

Investigateurs

F Beyersdorf (F)

M Grügerny (M)

R-R Macharzina (RR)

G Lechner (G)

C Menz (C)

S Schonhardt (S)

M Weinbeck (M)

O Greb (O)

D Otto (D)

T Winker (T)

H Berger (H)

H Poppert (H)

V Pütz (V)

K Haase (K)

U Bodechtel (U)

N Weiss (N)

H Bergert (H)

J Meyne (J)

J Groß (J)

A Botsch (A)

M Kruse (M)

B Gerdes (B)

W D Reinbold (WD)

H Wuttig (H)

A Maier-Hasselmann (A)

M Segerer (M)

H-H Fuchs (HH)

S Gass (S)

H Schultz (H)

C Groden (C)

M Niedergethman (M)

M Griebe (M)

M Rosenkranz (M)

C Beck (C)

G Thomalla (G)

H Zeumer (H)

M Jauß (M)

W Kneist (W)

M Kneist (M)

T Staudacher (T)

A Bernhard (A)

D Jost (D)

N Prey (N)

J Knippschild (J)

O Kastrup (O)

M Köhrmann (M)

B Frank (B)

V Bongers (V)

J Hoffmann (J)

H-W Kniemeyer (HW)

M Knauth (M)

K Wasser (K)

T Stojanovic (T)

H Emmert (H)

J Tacke (J)

B Schwalbe (B)

E-M Nam (EM)

U van Lengerich (U)

S Lowens (S)

K Gröschel (K)

T Uphaus (T)

S Gröschel (S)

S Boor (S)

B Dorweiler (B)

E Schmid (E)

H Henkes (H)

T Hupp (T)

O Singer (O)

G Hamann (G)

M Wagner-Heck (M)

S Kerth-Krick (S)

M Kilic (M)

P Huppert (P)

K Niederkorn (K)

J Fruhwirth (J)

G Klein (G)

U Pulkowski (U)

K Jöster (K)

J-H Wacks (JH)

E Kloppmann (E)

B Vatankhah (B)

S Hopf-Jensen (S)

H Stolze (H)

S Müller-Hülsbeck (S)

K P Walluscheck (KP)

H-M Schmitt (HM)

A Grüger (A)

J Seemann (J)

B Tilahun (B)

M Dichgans (M)

F Wollenweber (F)

A Dörr (A)

A Zollver (A)

G Gäbel (G)

G Hedtmann (G)

R Kollmar (R)

D Claus (D)

C Petermann (C)

S Kirsch (S)

B Bosnjak (B)

J Heiß (J)

H Mühling (H)

S Wunderlich (S)

P N Sabisch (PN)

G Gahn (G)

M Storck (M)

S Arnold (S)

U Fischer (U)

J Gralla (J)

M von Mering (M)

R Dißmann (R)

D Kirsch (D)

C Schmidauer (C)

P Waldenberger (P)

M Furtner (M)

H Kazarians (H)

P Breuer (P)

C Arning (C)

J Rieper (J)

G Schmidt (G)

M Arnold (M)

G Schroth (G)

J Weise (J)

J Zanow (J)

T Mayer (T)

R Töpper (R)

W Gross-Fengels (W)

H Daum (H)

R Dittrich (R)

M Ritter (M)

B Kasprzak (B)

G Torsello (G)

C Pohlmann (C)

R Brüning (R)

P Breuer (P)

H Amiri (H)

I Ludwig (I)

E Blessing (E)

M Möhlenbruch (M)

A Crispin (A)

M Hofman (M)

T Müller (T)

Informations de copyright

Déclaration de conflit d'intérêts

Declaration of Competing Interest All authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.