Type

Journal Article

Authors

S. (Sean) Murphy
Martin O'Connell
Ciaran McDonnell
John McCabe
Michael Marnane
Eoin Kavanagh
Gillian Horgan
Shane J Foley
Mary Barry
Jonathan P McNulty
and 3 others

Subjects

Medicine & Nursing

Topics
endarterectomy positron emission tomography ischemic attack transient inflammation diabetes mellitus hypertension prospective cohort study carotid stenosis

A Risk Score Including Carotid Plaque Inflammation and Stenosis Severity Improves Identification of Recurrent Stroke (2020)

Abstract Background and Purpose— In randomized trials of symptomatic carotid endarterectomy, only modest benefit occurred in patients with moderate stenosis and important subgroups experienced no benefit. Carotid plaque 18F-fluorodeoxyglucose uptake on positron emission tomography, reflecting inflammation, independently predicts recurrent stroke. We investigated if a risk score combining stenosis and plaque 18F-fluorodeoxyglucose would improve the identification of early recurrent stroke. Methods— We derived the score in a prospective cohort study of recent (<30 days) non-severe (modified Rankin Scale score ≤3) stroke/transient ischemic attack. We derived the SCAIL (symptomatic carotid atheroma inflammation lumen-stenosis) score (range, 0–5) including 18F-fluorodeoxyglucose standardized uptake values (SUVmax <2 g/mL, 0 points; SUVmax 2–2.99 g/mL, 1 point; SUVmax 3–3.99 g/mL, 2 points; SUVmax ≥4 g/mL, 3 points) and stenosis (<50%, 0 points; 50%–69%, 1 point; ≥70%, 2 points). We validated the score in an independent pooled cohort of 2 studies. In the pooled cohorts, we investigated the SCAIL score to discriminate recurrent stroke after the index stroke/transient ischemic attack, after positron emission tomography-imaging, and in mild or moderate stenosis. Results— In the derivation cohort (109 patients), recurrent stroke risk increased with increasing SCAIL score (P=0.002, C statistic 0.71 [95% CI, 0.56–0.86]). The adjusted (age, sex, smoking, hypertension, diabetes mellitus, antiplatelets, and statins) hazard ratio per 1-point SCAIL increase was 2.4 (95% CI, 1.2–4.5, P=0.01). Findings were confirmed in the validation cohort (87 patients, adjusted hazard ratio, 2.9 [95% CI, 1.9–5], P<0.001; C statistic 0.77 [95% CI, 0.67–0.87]). The SCAIL score independently predicted recurrent stroke after positron emission tomography-imaging (adjusted hazard ratio, 4.52 [95% CI, 1.58–12.93], P=0.005). Compared with stenosis severity (C statistic, 0.63 [95% CI, 0.46–0.80]), prediction of post-positron emission tomography stroke recurrence was improved with the SCAIL score (C statistic, 0.82 [95% CI, 0.66–0.97], P=0.04). Findings were confirmed in mild or moderate stenosis (adjusted hazard ratio, 2.74 [95% CI, 1.39–5.39], P=0.004). Conclusions— The SCAIL score improved the identification of early recurrent stroke. Randomized trials are needed to test if a combined stenosis-inflammation strategy improves selection for carotid revascularization where benefit is currently uncertain.
Collections Ireland -> University College Dublin -> Medicine Research Collection
Ireland -> University College Dublin -> College of Health and Agricultural Sciences
Ireland -> University College Dublin -> School of Medicine

Full list of authors on original publication

S. (Sean) Murphy, Martin O'Connell, Ciaran McDonnell, John McCabe, Michael Marnane, Eoin Kavanagh, Gillian Horgan, Shane J Foley, Mary Barry, Jonathan P McNulty and 3 others

Experts in our system

1
Martin O'Connell
University College Dublin
Total Publications: 3
 
2
Michael Marnane
University College Dublin
Total Publications: 15
 
3
Eoin Kavanagh
University College Dublin
Total Publications: 17
 
4
Gillian Horgan
University College Dublin
Total Publications: 12
 
5
Shane J Foley
University College Dublin
Total Publications: 6
 
6
Mary Barry
University College Dublin
Total Publications: 6
 
7
Jonathan P McNulty
University College Dublin
Total Publications: 27