Reclassification of Ischemic Stroke Etiological Subtypes on the Basis of High-Risk Nonstenosing Carotid Plaque

• DOI: 10.1161/strokeaha.119.027970
• Publication Date: 2019-12-18T10:00:15Z
• Authors: Hooman Kamel; Babak B. Navi; Alexander E. Merkler; Hediyeh Baradaran; Iván Díaz; Neal S. Parikh; Scott E. Kasner; David J. Gladstone; Costantino Iadecola; Ajay Gupta
• Keywords: Stroke; Magnetic resonance angiography; Etiology; McNemar's test

Background and Purpose— Carotid artery plaque with <50% luminal stenosis may be an underappreciated stroke mechanism. We assessed how many causes might reclassified after accounting for nonstenosing plaques high-risk features. Methods— included patients enrolled in the Cornell Acute Stroke Academic Registry from 2011 to 2015 who had anterior circulation infarction, magnetic resonance imaging of brain, angiography neck. High-risk was identified by intraplaque hemorrhage ascertained routine neck studies using validated methods. Infarct location determined diffusion-weighted imaging. Intraplaque infarct were separately a blinded fashion neuroradiologist. used McNemar test matched data compare prevalence ipsilateral versus contralateral brain infarction. subtypes including large-artery atherosclerosis as cause if there regardless degree stenosis. Results— Among 1721 acute ischemic registered 2015, 579 eligible this analysis. more common infarction atherosclerotic (risk ratio [RR], 3.7 [95% CI, 2.2–6.1]), cryptogenic (RR, 2.1 1.4–3.1]), cardioembolic strokes 1.7 1.1–2.4]). There nonsignificant ipsilateral-contralateral differences among lacunar 1.2 0.4–3.5]) other 1.5 0.7–3.3]). After plaque, 88 (15.2%) reclassified: 38 (22.6%) multiple potential etiologies, 6 (8.5%) multiple, 3 (15.8%) 41 (20.8%) atherosclerosis. Conclusions— carotid prevalent across several subtypes. Accounting such reclassify etiologies up 15% cases our sample.