Abstract
Background and Purpose: Internal carotid artery stenosis (ICAS)≥70% is a leading cause of ischemic cerebrovascular events (ICVEs). However, a considerable percentage of stroke survivors with symptomatic ICAS (sICAS) have <70% stenosis with a vulnerable plaque. Whether the length of ICAS is associated with high risk of ICVEs is poorly investigated. Our main aim was to investigate the relation between the length of ICAS and the development of ICVEs.Methods: In a retrospective cross-sectional study, we identified 95 arteries with sICAS and another 64 with asymptomatic internal carotid artery stenosis (aICAS) among 121 patients with ICVEs. The degree and length of ICAS as well as plaque echolucency were assessed on ultrasound scans.Results: A statistically significant inverse correlation between the ultrasound-measured length and degree of ICAS was detected for sICAS≥70% (Spearman correlation coefficient ρ = –0.57, p < 0.001, n = 51) but neither for sICAS<70% (ρ = 0.15, p = 0.45, n = 27) nor for aICAS (ρ = 0.07, p = 0.64, n = 54). The median (IQR) length for sICAS<70% and ≥70% was 17 (15–20) and 15 (12–19) mm (p = 0.06), respectively, while that for sICAS<90% and sICAS 90% was 18 (15–21) and 13 (10–16) mm, respectively (p < 0.001). Among patients with ICAS <70%, a cut-off length of ≥16 mm was found for sICAS rather than aICAS with a sensitivity and specificity of 74.1% and 51.1%, respectively. Irrespective of the stenotic degree, plaques of the sICAS compared to aICAS were significantly more often echolucent (43.2 vs. 24.6%, p = 0.02).Conclusion: We found a statistically insignificant tendency for the ultrasound-measured length of sICAS<70% to be longer than that of sICAS≥70%. Moreover, the ultrasound-measured length of sICAS<90% was significantly longer than that of sICAS 90%. Among patients with sICAS≥70%, the degree and length of stenosis were inversely correlated. Larger studies are needed before a clinical implication can be drawn from these results.
Highlights
Internal carotid artery stenosis (ICAS) causes around one-fifth of ischemic cerebrovascular stroke and has the highest risk of early stroke recurrence in comparison to other stroke subtypes such as cardioembolism or small artery occlusion [1,2,3]
There is a large body of literature showing that the risk of ICAS-related stroke recurrence correlates with the degree of stenosis; ICAS≥70% bears a higher risk compared to ICAS
We aimed to investigate whether (i) the length of ICAS is related to the occurrence of stroke or transient ischemic attacks (TIA) among patients with symptomatic ICAS (sICAS); (ii) there is a relationship between length and degree of ICAS, and whether (iii) plaque echolucency of ICAS
Summary
Internal carotid artery stenosis (ICAS) causes around one-fifth of ischemic cerebrovascular stroke and has the highest risk of early stroke recurrence in comparison to other stroke subtypes such as cardioembolism or small artery occlusion [1,2,3]. There is growing evidence that low-grade ICAS may lead to ischemic cerebrovascular events (ICVEs) [5, 6]. This observation raises the hypothesis that atherosclerotic plaques become unstable because of other characteristics (e.g., plaque composition) and may be prone to rupture (“vulnerable carotid plaque concept”) [7]. Internal carotid artery stenosis (ICAS)≥70% is a leading cause of ischemic cerebrovascular events (ICVEs).
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