AUTHOR=Elhfnawy Ahmed Mohamed , Volkmann Jens , Schliesser Mira , Fluri Felix 

TITLE=Symptomatic vs. Asymptomatic 20–40% Internal Carotid Artery Stenosis: Does the Plaque Size Matter?

JOURNAL=Frontiers in Neurology

VOLUME=10

YEAR=2019

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2019.00960

DOI=10.3389/fneur.2019.00960

ISSN=1664-2295

ABSTRACT=<p><bold>Background:</bold> Around 9–15% of ischemic strokes are related to internal carotid artery (ICA)-stenosis ≥50%. However, the extent to which ICA-stenosis &lt;50% causes ischemic cerebrovascular events is uncertain. We examined the relation between plaque cross-sectional area and length and the risk of ischemic stroke or TIA among patients with ICA-stenosis of 20–40%.</p><p><bold>Methods:</bold> We retrospectively identified patients admitted to the Department of Neurology, University Hospital of Würzburg, from January 2011 until September 2016 with ischemic stroke or TIA and concomitant ICA-stenosis of 20–40%, either symptomatic or asymptomatic. Plaque length and cross-sectional area were assessed on ultrasound scans.</p><p><bold>Results:</bold> We identified 41 patients with ischemic stroke or TIA and ICA-stenosis of 20–40%; 14 symptomatic and 27 asymptomatic. The plaque cross-sectional area was significantly larger among symptomatic than asymptomatic ICA-stenosis; median values (IQR) were 0.45 (0.21–0.69) cm<sup>2</sup> and 0.27 (0.21–0.38) cm<sup>2</sup>, <italic>p</italic> = 0.03, respectively. A plaque cross-sectional area ≥0.36 cm<sup>2</sup> had a sensitivity of 71% and a specificity of 76% for symptomatic compared with asymptomatic ICA-stenosis. In a sex-adjusted multivariate logistic regression, a plaque cross-sectional area ≥0.36 cm<sup>2</sup> and a plaque length ≥1.65 cm were associated with an OR (95% CI) of 5.54 (1.2–25.6), <italic>p</italic> = 0.028 and 1.78 (0.36–8.73), <italic>p</italic> = 0.48, respectively, for symptomatic ICA-stenosis.</p><p><bold>Conclusion:</bold> Large plaques might increase the risk of ischemic stroke or TIA among patients with low-grade ICA-stenosis of 20–40%. Sufficiently powered prospective longitudinal cohort studies are needed to definitively test the stroke risk stratification value of carotid plaque length and cross-sectional area in the setting of current optimal medical treatment.</p>