A large prevalence of ipsilateral nonstenotic carotid plaques was found in patients with embolic strokes of undetermined source (ESUS), and the presence of nonstenotic carotid plaques was shown to reduce the rate of atrial fibrillation (AF) detection during follow-up, according to study results published in Neurology.

Researchers of this large, multicenter study pooled the data of 777 consecutive patients with ESUS from 3 prospective stroke registries and followed them for a mean follow-up of 2642 patient-years (PY) to investigate the association between the presence of nonstenotic carotid plaques among patients with ESUS and the detection of AF. The investigators used the Kaplan-Meier product limit method to estimate the 10-year cumulative probabilities of AF detection.

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Among the 777 patients (43.3% women; median age 67 [interquartile range, 54-77] years) followed, 38.6% (n=341) had an ipsilateral nonstenotic carotid plaque. During a median follow-up of 23 (interquartile range, 9-64) months, AF was detected in 14.4% (n=112) of patients, with an overall detection rate of 8.5% in patients with nonstenotic carotid plaques (2.9%/100 PY) and of 19% in patients without nonstenotic carotid plaques (5%/100 PY) (unadjusted hazard ratio [HR] 0.56; 95% CI, 0.37-0.84). Ipsilateral nonstenotic carotid plaque presence was associated with a lower probability for detection of AF (adjusted HR 0.57; 95% CI, 0.34-0.96; P =.03), and patients with ipsilateral nonstenotic carotid plaque presence had a lower 10-year cumulative probability of AF detection than patients without (34.5%; 95% CI, 21.8-47.2 vs 49%; 95% CI, 40.4-57.6, respectively; log-rank test 11.8; P =.001). The annualized rate of stroke recurrence was 3.8% (n = 101) overall, 4.2% in patients with nonstenotic carotid plaques (n = 42), and 3.6% in patients without (n = 59) (unadjusted HR 1.27; 95% CI, 0.85-1.89). The investigators did not observe any statistical difference in the 10-year cumulative probability of stroke recurrence between patients with nonstenotic carotid plaques and patients without (35.9%; 95% CI, 27.3-44.5 vs 45.9%; 95% CI, 33.6-58.2; respectively; log-rank test 0.947; P =.331).

Study investigators concluded, “In our cohort, AF was less frequently detected in ESUS patients with nonstenotic carotid plaques compared to those without. This evidence may be useful in the clinical setting to guide the optimal diagnostic strategy in ESUS patients, as well as for the design of trials of secondary prevention in ESUS patients.”

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Multiple study authors reported affiliations with pharmaceutical companies. See reference for complete disclosure information.


Ntaios G, Perlepe K, Sirimarco G, et al. Carotid plaques and detection of atrial fibrillation in embolic stroke of undetermined source [published online May 8, 2019]. Neurology. doi:10.1212/WNL.0000000000007611