Contralateral Stenosis and Echolucent Plaque Morphology are Associated with Elevated Stroke Risk in Patients Treated with Asymptomatic Carotid Artery Stenosis within a Controlled Clinical Trial (SPACE-2)
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Contralateral Stenosis and Echolucent Plaque Morphology are Associated with Elevated Stroke Risk in Patients Treated with Asymptomatic Carotid Artery Stenosis within a Controlled Clinical Trial (SPACE-2). / Reiff, Tilman; Eckstein, Hans-Henning; Mansmann, Ulrich; Jansen, Olav; Fraedrich, Gustav; Mudra, Harald; Böckler, Dittmar; Böhm, Michael; Brückmann, Hartmut; Debus, E Sebastian; Fiehler, Jens; Mathias, Klaus; Ringelstein, E Bernd; Schmidli, Jürg; Stingele, Robert; Zahn, Ralf; Zeller, Thomas; Niesen, Wolf-Dirk; Barlinn, Kristian; Binder, Andreas; Glahn, Jörg; Ringleb, Peter Arthur; SPACE-2 Investigators.
In: J STROKE CEREBROVASC, Vol. 30, No. 9, 105940, 09.2021.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Contralateral Stenosis and Echolucent Plaque Morphology are Associated with Elevated Stroke Risk in Patients Treated with Asymptomatic Carotid Artery Stenosis within a Controlled Clinical Trial (SPACE-2)
AU - Reiff, Tilman
AU - Eckstein, Hans-Henning
AU - Mansmann, Ulrich
AU - Jansen, Olav
AU - Fraedrich, Gustav
AU - Mudra, Harald
AU - Böckler, Dittmar
AU - Böhm, Michael
AU - Brückmann, Hartmut
AU - Debus, E Sebastian
AU - Fiehler, Jens
AU - Mathias, Klaus
AU - Ringelstein, E Bernd
AU - Schmidli, Jürg
AU - Stingele, Robert
AU - Zahn, Ralf
AU - Zeller, Thomas
AU - Niesen, Wolf-Dirk
AU - Barlinn, Kristian
AU - Binder, Andreas
AU - Glahn, Jörg
AU - Ringleb, Peter Arthur
AU - SPACE-2 Investigators
N1 - Copyright © 2021 Elsevier Inc. All rights reserved.
PY - 2021/9
Y1 - 2021/9
N2 - BACKGROUND: Asymptomatic carotid artery stenosis (ACS) has a low risk of stroke. To achieve an advantage over noninterventional best medical treatment (BMT), carotid endarterectomy (CEA) or carotid artery stenting (CAS) must be performed with the lowest possible risk of stroke. Therefore, an analysis of risk-elevating factors is essential. Grade of ipsilateral and contralateral stenosis as well as plaque morphology are known risk factors in ACS.METHODS: The randomized, controlled, multicenter SPACE-2 trial had to be stopped prematurely after recruiting 513 patients. 203 patients were randomized to CEA, 197 to CAS, and 113 to BMT. Within one year, risk factors such as grade of stenosis and plaque morphology were analyzed.RESULTS: Grade of contralateral stenosis (GCS) was higher in patients with any stroke (50%ECST vs. 20%ECST; p=0.012). Echolucent plaque morphology was associated with any stroke on the day of intervention (OR 5.23; p=0.041). In the periprocedural period, any stroke was correlated with GCS in the CEA group (70%ECST vs. 20%ECST; p=0.026) and with echolucent plaque morphology in the CAS group (6% vs. 1%; p=0.048). In multivariate analysis, occlusion of the contralateral carotid artery (CCO) was associated with risk of any stroke (OR 7.00; p=0.006), without heterogeneity between CEA and CAS.CONCLUSION: In patients with asymptomatic carotid artery stenosis, GCS, CCO, as well as echolucent plaque morphology were associated with a higher risk of cerebrovascular events. The risk of stroke in the periprocedural period was increased by GCS in CEA and by echolucent plaque in CAS. Due to small sample size, results must be interpreted carefully.
AB - BACKGROUND: Asymptomatic carotid artery stenosis (ACS) has a low risk of stroke. To achieve an advantage over noninterventional best medical treatment (BMT), carotid endarterectomy (CEA) or carotid artery stenting (CAS) must be performed with the lowest possible risk of stroke. Therefore, an analysis of risk-elevating factors is essential. Grade of ipsilateral and contralateral stenosis as well as plaque morphology are known risk factors in ACS.METHODS: The randomized, controlled, multicenter SPACE-2 trial had to be stopped prematurely after recruiting 513 patients. 203 patients were randomized to CEA, 197 to CAS, and 113 to BMT. Within one year, risk factors such as grade of stenosis and plaque morphology were analyzed.RESULTS: Grade of contralateral stenosis (GCS) was higher in patients with any stroke (50%ECST vs. 20%ECST; p=0.012). Echolucent plaque morphology was associated with any stroke on the day of intervention (OR 5.23; p=0.041). In the periprocedural period, any stroke was correlated with GCS in the CEA group (70%ECST vs. 20%ECST; p=0.026) and with echolucent plaque morphology in the CAS group (6% vs. 1%; p=0.048). In multivariate analysis, occlusion of the contralateral carotid artery (CCO) was associated with risk of any stroke (OR 7.00; p=0.006), without heterogeneity between CEA and CAS.CONCLUSION: In patients with asymptomatic carotid artery stenosis, GCS, CCO, as well as echolucent plaque morphology were associated with a higher risk of cerebrovascular events. The risk of stroke in the periprocedural period was increased by GCS in CEA and by echolucent plaque in CAS. Due to small sample size, results must be interpreted carefully.
KW - Aged
KW - Asymptomatic Diseases
KW - Carotid Intima-Media Thickness
KW - Carotid Stenosis/complications
KW - Endarterectomy, Carotid/adverse effects
KW - Endovascular Procedures/adverse effects
KW - Europe
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Plaque, Atherosclerotic
KW - Predictive Value of Tests
KW - Prospective Studies
KW - Risk Assessment
KW - Risk Factors
KW - Stents
KW - Stroke/diagnosis
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1016/j.jstrokecerebrovasdis.2021.105940
DO - 10.1016/j.jstrokecerebrovasdis.2021.105940
M3 - SCORING: Journal article
C2 - 34311420
VL - 30
JO - J STROKE CEREBROVASC
JF - J STROKE CEREBROVASC
SN - 1052-3057
IS - 9
M1 - 105940
ER -
