Clinical Features, Radiological Findings, and Outcome in Patients with Symptomatic Mild (<50%) Carotid Stenosis: A MUSIC Study

• DOI: 10.1101/2024.05.02.24306793
• Publication Date: 2024-05-04T21:15:18Z
• Authors: Daina Kashiwazaki; Kohei Chida; Kazumichi Yoshida; Kiyofumi Yamada; Motohiro Morioka; Katsuhiko Maruichi; Emiko Hori; Naoki Akioka; Yasushi Takagi; Junta Moroi; Susumu Miyamoto; Toru Iwama; Masaki Chin; Kenji Kamiyama; Kojiro Wada; Nobuyuki Sakai; Tsuyoshi Izumo; Yusuke Nishikawa; Mitsuhito Mase; Kohkichi Hosoda; Katsumi Takizawa; Eiichi Kobayashi; Michiya Kubo; Atsushi Fujita; Taku Sugiyama; Miki Fujimura; Hideyuki Yoshioka; Hiroyuki Kinouchi; Takeharu Kunieda; Ataru Nishimura; Shinichi Yoshimura; Yoshiaki Shiokawa; Hiroshi Abe; Hiroharu Kataoka; Kuniaki Ogasawara; Masaaki Uno; Makoto Sasaki; Satoshi Kuroda

Abstract Background and Purpose Plaque composition, but not stenosis degree, may play a key role in the development of recurrent ischemic events patients with symptomatic, mild (&lt;50%) carotid stenosis. This multi-center prospective cohort study was aimed to determine their clinical radiological features evaluate benefits endarterectomy (CEA) for them. Methods included 124 cerebrovascular or retinal ipsilateral Best medical therapy (BMT) administered all participants. CEA artery stenting (CAS) implemented at each institution’s discretion. Baseline 6-, 12-, 24-month follow-up data were collected. Primary endpoint stroke. Secondary endpoints any stroke, TIA, ocular symptoms, death, plaque progression requiring CEA/CAS. Multivariate Cox proportional hazard model used predictors endpoint. Results Of patients, 70 (56.5%) had history stroke 51 (43.5%) been treated antiplatelet agents. Mean degree 22.4±13.7%. composition categorized into fibrous 22 lipid-rich/necrotic core (LR/NC) 25, intraplaque hemorrhage (IPH) 69. BMT indicated 59 while performed 63. The incidence primary significantly higher group than (15.1% vs. 1.7%; HR, 0.18; 95%CI, 0.05–0.84; P=0.03). (HR, P=0.03) IPH 1.92; 1.26–4.28; P=0.04). results on secondary very similar. Conclusion highly predict subsequent events, whereas reduce these risk during 2-year Registration has registered University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) (UMIN000023635). Contributors SK, KO, UM, MS designed study. DK wrote an original draft. All authors recruited patients. DK, KC, KY, MM, SY, SM, MU, MS, SK analyzed imaging as members Central Judgement Committee contributed analysis. takes final responsibility submitted publication.