Stenosis May Be Responsible for More Acute Ischemic Strokes

HealthDay News — Some ischemic strokes are not being ascribed to large-artery atherosclerosis because of <50% stenosis, according to a letter to the editor published in JACC: Cardiovascular Imaging to coincide with the annual American Stroke Association’s International Stroke Conference, held from Feb. 17 to 19 in Los Angeles.

Ajay Gupta, MD, from the Weill Cornell Medical College in New York City, and colleagues used data from a prospective stroke registry to examine the correlation between non-stenosing, vulnerable large-artery plaque and ischemic stroke, focusing on stroke from cardioembolism, small-vessel occlusion, and undetermined cause. They included 109 eligible patients with acute brain infarction limited to the vascular territory of a single internal carotid artery (ICA), as confirmed on magnetic resonance imaging.

The researchers found that 20.2% of the patients had <50% ICA plaques with intraplaque high-intensity signal (IHIS) ipsilateral to the side of infarction, whereas 8.3% of patients had IHIS in <50% ICA plaque contralateral to the side of infarction (P = 0.01). Patients with cryptogenic stroke had a significantly higher proportion of IHIS in ICA plaques ipsilateral to the side of infarction (P < 0.001); this was not seen in patients with strokes from cardioembolism or small-vessel occlusion (P = 0.76 and 0.49, respectively).

“Some strokes from large-artery atherosclerosis are currently not being recognized as such because the plaque causes <50% stenosis,” the authors write.

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Gupta A, Gialdini G, Giambrone AE, et al. Association Between Nonstenosing Carotid Artery Plaque on MR Angiography and Acute Ischemic Stroke. J Am Coll Cardiol Img. 2016; doi:10.1016/j.jcmg.2015.12.004.