Plaque echolucency and the risk of ischaemic stroke in patients with asymptomatic carotid stenosis within the first asymptomatic carotid surgery trial (ACST-1)
<h4>Objective/Background</h4> <p>On ultrasound, potentially “high risk” carotid plaques may appear echolucent. In this study, whether a confident classification of echolucent plaque was a predictor of future ipsilateral ischaemic stroke in asymptomatic patients randomized to medica...
| Հիմնական հեղինակներ: | , , , , |
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| Ձևաչափ: | Journal article |
| Հրապարակվել է: |
Elsevier
2015
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| _version_ | 1826268289643315200 |
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| author | Huibers, A de Borst, G Bulbulia, R Pan, H Halliday, A |
| author_facet | Huibers, A de Borst, G Bulbulia, R Pan, H Halliday, A |
| author_sort | Huibers, A |
| collection | OXFORD |
| description | <h4>Objective/Background</h4> <p>On ultrasound, potentially “high risk” carotid plaques may appear echolucent. In this study, whether a confident classification of echolucent plaque was a predictor of future ipsilateral ischaemic stroke in asymptomatic patients randomized to medical therapy in the Asymptomatic Carotid Surgery Trial-1 (ACST-1) was assessed.</p> <h4>Methods</h4> <p>We performed a post-hoc analysis of 814 ACST-1 patients randomized to medical therapy alone with baseline plaque assessment classified as definitely echolucent (>25% soft plaque) or nonecholucent (<25% soft plaque). KaplaneMeier survival curves were used to compare cumulative rates of ipsilateral ischaemic stroke in both groups.</p> <h4>Results</h4> <p>In the first 5 years after randomization, a significantly higher risk of ipsilateral stroke was observed in patients with definitely echolucent plaques (8.0%; 95% confidence interval [CI] 6.4-9.6) when compared with patients with definitely nonecholucent plaques (3.1%; 95% CI 2.1e4.1;p=.009). After adjustments for other risk factors, plaque echolucency was associated with a 2.5-times increased risk of ipsilateral ischaemic stroke (hazard ratio 2.52; 95% CI 1.20e5.25;p=.014). Use of lipid-lowering therapy was low in both groups during the first 5 years after randomization but rose sharply during years 5e10 of follow-up, and was significantly more likely to be prescribed for patients with echolucent plaques (p=.001). The risk of ipsilateral ischaemic stroke at 10 years was similar for both groups of patients (p=.233).</p> <h4>Conclusion</h4> <p>Although the numbers of events in this study was low, definite plaque echolucency (>25% soft plaque) was associated with a higher 5-year ipsilateral stroke risk in ACST-1 and may therefore help to identify patients at increased risk of stroke for whom carotid intervention may be particularly beneficial. </p> |
| first_indexed | 2024-03-06T21:07:23Z |
| format | Journal article |
| id | oxford-uuid:3cf1d54c-dbb5-4484-9327-9a6ae9e9a18c |
| institution | University of Oxford |
| last_indexed | 2024-03-06T21:07:23Z |
| publishDate | 2015 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:3cf1d54c-dbb5-4484-9327-9a6ae9e9a18c2022-03-26T14:16:36ZPlaque echolucency and the risk of ischaemic stroke in patients with asymptomatic carotid stenosis within the first asymptomatic carotid surgery trial (ACST-1)Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:3cf1d54c-dbb5-4484-9327-9a6ae9e9a18cSymplectic Elements at OxfordElsevier2015Huibers, Ade Borst, GBulbulia, RPan, HHalliday, A<h4>Objective/Background</h4> <p>On ultrasound, potentially “high risk” carotid plaques may appear echolucent. In this study, whether a confident classification of echolucent plaque was a predictor of future ipsilateral ischaemic stroke in asymptomatic patients randomized to medical therapy in the Asymptomatic Carotid Surgery Trial-1 (ACST-1) was assessed.</p> <h4>Methods</h4> <p>We performed a post-hoc analysis of 814 ACST-1 patients randomized to medical therapy alone with baseline plaque assessment classified as definitely echolucent (>25% soft plaque) or nonecholucent (<25% soft plaque). KaplaneMeier survival curves were used to compare cumulative rates of ipsilateral ischaemic stroke in both groups.</p> <h4>Results</h4> <p>In the first 5 years after randomization, a significantly higher risk of ipsilateral stroke was observed in patients with definitely echolucent plaques (8.0%; 95% confidence interval [CI] 6.4-9.6) when compared with patients with definitely nonecholucent plaques (3.1%; 95% CI 2.1e4.1;p=.009). After adjustments for other risk factors, plaque echolucency was associated with a 2.5-times increased risk of ipsilateral ischaemic stroke (hazard ratio 2.52; 95% CI 1.20e5.25;p=.014). Use of lipid-lowering therapy was low in both groups during the first 5 years after randomization but rose sharply during years 5e10 of follow-up, and was significantly more likely to be prescribed for patients with echolucent plaques (p=.001). The risk of ipsilateral ischaemic stroke at 10 years was similar for both groups of patients (p=.233).</p> <h4>Conclusion</h4> <p>Although the numbers of events in this study was low, definite plaque echolucency (>25% soft plaque) was associated with a higher 5-year ipsilateral stroke risk in ACST-1 and may therefore help to identify patients at increased risk of stroke for whom carotid intervention may be particularly beneficial. </p> |
| spellingShingle | Huibers, A de Borst, G Bulbulia, R Pan, H Halliday, A Plaque echolucency and the risk of ischaemic stroke in patients with asymptomatic carotid stenosis within the first asymptomatic carotid surgery trial (ACST-1) |
| title | Plaque echolucency and the risk of ischaemic stroke in patients with asymptomatic carotid stenosis within the first asymptomatic carotid surgery trial (ACST-1) |
| title_full | Plaque echolucency and the risk of ischaemic stroke in patients with asymptomatic carotid stenosis within the first asymptomatic carotid surgery trial (ACST-1) |
| title_fullStr | Plaque echolucency and the risk of ischaemic stroke in patients with asymptomatic carotid stenosis within the first asymptomatic carotid surgery trial (ACST-1) |
| title_full_unstemmed | Plaque echolucency and the risk of ischaemic stroke in patients with asymptomatic carotid stenosis within the first asymptomatic carotid surgery trial (ACST-1) |
| title_short | Plaque echolucency and the risk of ischaemic stroke in patients with asymptomatic carotid stenosis within the first asymptomatic carotid surgery trial (ACST-1) |
| title_sort | plaque echolucency and the risk of ischaemic stroke in patients with asymptomatic carotid stenosis within the first asymptomatic carotid surgery trial acst 1 |
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