Abstract
BackgroundExtracranial carotid artery disease is considered a risk factor for developing acute cerebrovascular diseases. The paper suggests the “Stroke-Stop” formula as hypothesis for the determination of the risk of developing stroke in asymptomatic individuals with carotid stenosis. The formula is based on a mathematical calculation of the major risk factors for stroke: the degree of ICA (internal carotid artery) stenosis, the morphological structure of the atherosclerotic plaque and the level of lipoprotein-associated phospholipase A2 (Lp-PLA2) concentration.MethodsThe cross sectional study included 70 patients with atherosclerotic ICA stenosis. Among vascular inflammatory markers, Lp-PLA2 was determined with concentration 252.7–328.6 mg/l. The obtained results were evaluated using descriptive statistics (the frequency, percentage ratio) as well as the one-way analysis of variance (ANOVA) and chi-square test.ResultsThe risk of stroke development is eminently increasing with the progression of ICA stenosis and elevation of Lp-PLA2 levels. In patients with echolucent plaque, the risk of stroke development was significantly higher in correlation with patients with echogenic plaque. Based on calculations using “Stroke-Stop” formula, three main groups were generated: low (< 70 points), medium (70–100 points) and high (> 100 points) risk of stroke development.ConclusionsHypothesis of “Stroke-Stop” formula is proposed for better selection of patients who should be indicated for surgical treatment and will be evaluated in prospective study. In order to verify this hypothesis, we plan to do prospective study using “Stroke-Stop” formula for ipsilateral annual stroke rate in asymptomatic individuals with carotid stenosis who receive conservative therapy.
Highlights
Extracranial carotid artery disease is considered a risk factor for developing acute cerebrovascular diseases
Depending on the clinical course, the patients were divided into two groups: Group I included 30 (43% of all 70 tested) symptomatic individuals with carotid stenosis; among them, 20 (66.6% of Group I) patients had a history of ischemic stroke, and 10 (33.3% of Group I) patients had a history of transient ischemic attack (TIA); Group II included 40 (57% of all 70 tested) asymptomatic individuals with carotid stenosis
When studying vascular inflammatory markers, the ratio of lipoprotein-associated phospholipase A2 (Lp-PLA2) concentration was compared between patients of Group I and those of Group II
Summary
Extracranial carotid artery disease is considered a risk factor for developing acute cerebrovascular diseases. The formula is based on a mathematical calculation of the major risk factors for stroke: the degree of ICA (internal carotid artery) stenosis, the morphological structure of the atherosclerotic plaque and the level of lipoprotein-associated phospholipase A2 (Lp-PLA2) concentration. Due to timely diagnosis and administration of conservative treatment (antiplatelet therapy), over the last 3–4 decades the rate of stroke in asymptomatic and symptomatic individuals with carotid stenosis has fallen significantly [4, 5]. Despite this trend, a lot of individuals with carotid stenosis receive endovascular or surgical treatment (CAS/CEA) [5, 6]. The annual rate of stroke in the NASCET trial with 70–99% stenosis (using outcomes at 2 years), was 13% and approximately 7%/year for 50–69% stenosis [7]
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