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Plaque neovascularization detected with contrast‐enhanced ultrasound predicts ischaemic stroke recurrence in patients with carotid atherosclerosis
Author(s) -
CampsRenom P.,
PratsSánchez L.,
Casoni F.,
GonzálezdeEchávarri J. M.,
MarreroGonzález P.,
Castrillón I.,
Marín R.,
JiménezXarrié E.,
DelgadoMederos R.,
MartínezDomeño A.,
GuisadoAlonso D.,
MartíFàbregas J.
Publication year - 2020
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.14157
Subject(s) - medicine , stroke (engine) , neovascularization , stenosis , hazard ratio , interquartile range , contrast enhanced ultrasound , proportional hazards model , radiology , cardiology , ultrasound , neuroradiology , prospective cohort study , confidence interval , angiogenesis , neurology , mechanical engineering , psychiatry , engineering
Background and purpose Plaque neovascularization is a hallmark of carotid plaque vulnerability. With contrast‐enhanced ultrasound (CEUS) it is possible to visualize plaque neovessels in vivo . Our aim was to determine if CEUS‐detected neovessels were associated with stroke recurrences in patients with a recent stroke and carotid atherosclerosis. Methods We conducted a prospective study of consecutive patients with a recent stroke and at least one atherosclerotic plaque in the internal carotid artery on the side consistent with symptoms. All of our patients underwent a carotid ultrasound examination including a CEUS study. Neovascularization was graded into three categories according to the extent of neovessels. During the follow‐up, we recorded stroke recurrences. A multivariable Cox regression analysis was performed to evaluate predictors of recurrence. Results We included 78 patients whose mean age was 74.3 ± 10.4 years. There were 29 (37.2%) patients with a low‐grade stenosis (<50%). The remainder presented moderate (50%–69%) or high‐grade (≥70%) stenosis. CEUS was not interpretable in 35.9% of the patients, mainly due to calcium shadows. We detected neovascularization in 80% of the plaques. After a median follow‐up of 14.1 (interquartile range, 9.5‐19.6) months, there were 15 (19.2%) stroke recurrences. In the Cox regression analysis, CEUS‐detected neovascularization was independently associated with the risk of stroke recurrence, even after adjusting for the degree of stenosis (hazard ratio, 6.57; 95% confidence interval, 1.66–26.01). Conclusion In patients with an anterior circulation ischaemic stroke and carotid atherosclerosis, plaque neovascularization detected with CEUS was an independent predictor of stroke recurrence.