Plaque Echolucency and the Risk of Ischaemic Stroke in Patients with Asymptomatic Carotid Stenosis Within the First Asymptomatic Carotid Surgery Trial (ACST-1). Issue 5 (May 2016)

• Record Type: Journal Article
• Authors: Huibers, A.; de Borst, G.J.; Bulbulia, R.; Pan, H.; Halliday, A.
• Is Part Of: European journal of vascular and endovascular surgery. Volume 51:Issue 5(2016:May)
• Page Start: 616
• Page End: 621
• Publication Date: 2016-05
• Subjects: Carotid artery stenosis -- Carotid echolucency -- Carotid ultrasound -- Randomized trial -- Stroke; Blood-vessels -- Endoscopic surgery -- Periodicals; Blood-vessels -- Surgery -- Periodicals; Vascular Surgical Procedures -- Periodicals; Vascular Surgical Procedures -- methods -- Periodicals; Vaisseaux sanguins -- Chirurgie -- Périodiques; Vaisseaux sanguins -- Chirurgie endoscopique -- Périodiques; Blood-vessels -- Endoscopic surgery; Blood-vessels -- Surgery; Endoscopy; Electronic journals; Periodicals; Electronic journals; 617.413005
• DOI: 10.1016/j.ejvs.2015.11.013
• Languages: English
• ISSNs: 1078-5884

Abstract

Abstract : Objective/Background: On ultrasound, potentially "high risk" carotid plaques may appear echolucent. In this study, whether a confident classification of echolucent plaque was a predictor of future ipsilateral ischaemic stroke in asymptomatic patients randomized to medical therapy in the Asymptomatic Carotid Surgery Trial-1 (ACST-1) was assessed. Methods: We performed a post-hoc analysis of 814 ACST-1 patients randomized to medical therapy alone with baseline plaque assessment classified as definitely echolucent (> 25% soft plaque) or nonecholucent (< 25% soft plaque). Kaplan–Meier survival curves were used to compare cumulative rates of ipsilateral ischaemic stroke in both groups. Results: In the first 5 years after randomization, a significantly higher risk of ipsilateral stroke was observed in patients with definitely echolucent plaques (8.0%; 95% confidence interval [CI] 6.4–9.6) when compared with patients with definitely nonecholucent plaques (3.1%; 95% CI 2.1–4.1; p = .009). After adjustments for other risk factors, plaque echolucency was associated with a 2.5-times increased risk of ipsilateral ischaemic stroke (hazard ratio 2.52; 95% CI 1.20–5.25; p = .014). Use of lipid-lowering therapy was low in both groups during the first 5 years after randomization but rose sharply during years 5–10 of follow-up, and was significantly more likely to be prescribed for patients with echolucent plaques ( p = .001). The risk of ipsilateral ischaemic stroke at 10 years was similar for both groups of patients ( p = .233). Conclusion: Although the numbers of events in this study was low, definite plaque echolucency (> 25% soft plaque) was associated with a higher 5-year ipsilateral stroke risk in ACST-1 and may therefore help to identify patients at increased risk of stroke for whom carotid intervention may be particularly beneficial.