Symptomatic nonstenotic carotid disease: Evaluation of a proposed classification scheme in a prospective cohort. (August 2021)

• Record Type: Journal Article
• Authors: Tonetti, Daniel A.; Desai, Shashvat M.; Nayar, Gautam; Jankowitz, Brian T.; Jovin, Tudor G.; Jadhav, Ashutosh P.
• Is Part Of: Journal of clinical neuroscience. Volume 90(2021)
• Page Start: 21
• Page End: 25
• Publication Date: 2021-08
• Subjects: Symptomatic nonstenotic carotid disease -- Carotid stenosis -- Acute ischemic stroke -- Anterior circulation -- Extracranial carotid disease -- Carotid atherosclerosis; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2021.04.039
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Symptomatic nonstenotic carotid (SyNC) disease may be a cause of stroke despite < 50% carotid stenosis. Many patients otherwise classified as ESUS may meet criteria for definite or probable SyNC. SyNC classification schemes may be useful for risk stratification. Abstract: Introduction: Unraveling symptomatic nonstenotic carotid disease (SyNC) as a stroke etiology from other cryptogenic stroke may have important implications for defining natural history and for tailoring secondary prevention strategies. We aim to describe the characteristics of the plaques in a prospectively-collected cohort of patients with non-invasive imaging suggesting symptomatic carotid stenosis but whose DSA demonstrated nonstenotic atheromatous disease, and to evaluate the recurrence rate depending on the type of SyNC. Methods: We reviewed prospectively-collected data for patients presenting with new neurologic events and non-invasive imaging suggestive of moderate or severe (≥50%) carotid stenosis between July 2016 and October 2018. Patients were included in the present study if the degree of stenosis on DSA was < 50%. We assigned these patients into groups based on a previously-proposed working definition of SyNC, and analyzed the rate of recurrent stroke in the following 6 months. Results: 28 patients had DSA-confirmed < 50% stenosis and constituted the study cohort. The median age was 73 years and 64% were male; median presenting NIHSS was 1 (IQR 0–3). The great majority (86%) of carotid plaques had high-risk features including ulcerated plaque (n = 21, 75%) and plaque > 3 mm thick (n = 18, 64%). 17 of 28 patients (61%) met classification criteria for "definite" or "probable" SyNC. Three of five patients in the "definite SyNC" group experienced recurrent neurologic events. Conclusion: The majority of patients with non-invasive imaging suggesting carotid stenosis harbor symptomatic carotid disease per current classifications despite DSA stenosis < 50%. Current classification schema may allow for risk stratification of SyNC patients and these findings warrant further study.