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LOS ANGELES -- Atherosclerotic plaque in the carotid arteries may be associated with stroke even when not blocking more than half of the vessel, a prospective registry study showed.
Among 109 patients with stroke from cardioembolism, small-vessel occlusion, or undetermined causes, 20.2% had a vulnerable plaque causing a less than 50% stenosis on the same side as their infarct, whereas 8.3% had a vulnerable plaque -- determined by a marker of intraplaque hemorrhage on standard MRI angiograms -- on the contralateral side (P=0.01).
The association was significant only among cryptogenic stroke patients, , of Weill Cornell Medical College in New York City, and colleagues reported online in JACC: Cardiovascular Imaging in conjunction with presentation at the International Stroke Conference here.
These findings may have implications for secondary prevention, the researchers noted.
"Our results suggest that some strokes from large-artery atherosclerosis are currently not being recognized as such because the plaque causes <50% stenosis," they wrote.
"Our findings also suggest that useful plaque composition data can be extracted using only a standard luminal imaging technique (TOF MRA) that can be integrated into a rapid acute stroke imaging protocol," they added. "Because our intraplaque high-intensity signal positive subgroup was small (n=31), larger confirmatory prospective studies are now warranted which should also investigate stroke recurrence rates in such patients.
"Such studies are important because if patients who are currently labeled as cryptogenic stroke are more correctly identified as harboring a culprit large-artery atherosclerotic lesion, they may benefit from intensified and targeted therapy aimed at reducing their risk of recurrent stroke and other major adverse cardiovascular events."
If nonstenosing plaque could be identified as the cause of stroke, "such patients may benefit from dual antiplatelet drugs and emerging drugs for lowering serum cholesterol," they added.
From the American Heart Association:
Disclosures
Gupta disclosed support from the Foundation of the American Society of Neuroradiology Scholar Award.
The researchers disclosed no relevant relationships with industry.
Primary Source
JACC: Cardiovascular Imaging
Gupta A, et al "Association between Non-Stenosing Carotid Artery Plaque on Magnetic Resonance Angiography and Acute Ischemic Stroke" JACC Cardiovasc Imaging 2016.