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Título

MILD CAROTID STENOSIS FREQUENCY IN PATIENTS WITH EMBOLIC ISCHEMIC STROKE OF UNDETERMINED SOURCE (ESUS)

Resumo

Introduction: Etiological classifications define carotid stenosis ≥50% as a source of ischemic stroke. However, some studies showed a higher frequency of mild carotid stenosis (<50%) ipsilateral to Embolic Ischemic Stroke of Undetermined Source (ESUS), as well as high-risk features, such as intraplaque hemorrhage, thrombus and ulceration.
Objectives: To investigate the frequency of mild carotid stenosis and to assess whether it occurs more frequently ipsilateral than contralateral to cerebral infarction in ESUS.
Methods: Cross-sectional study based on medical records of adult (≥18 years) ESUS patients from a stroke outpatient clinic. ESUS was defined as imaging-confirmed non-lacunar stroke; absence of ≥50% stenosis on arteries that supply the area of ischemia; and no cardioembolic or other rare specific sources of stroke. The frequencies of mild carotid stenosis and side of cerebral infarction were compared using Fisher's exact test.
Results: A total of 55 participants with ESUS were enrolled. The mean age was 61±11.3 years and 28 (50.9%) were women. Mild carotid disease was present in 27 individuals (49.1%) and this group was significantly older (65.4±9.3 vs 56.8±12.2, p<0.001). Among these, 21 (77.8%) had bilateral mild carotid stenosis and unilateral cerebral infarction and two (7.4%) had bilateral stenosis and bilateral infarcts. Of patients with unilateral stenosis, two (7.4%) had contralateral and one (3.7%) had ipsilateral infarct. One (3.7%) participant presented with unilateral stenosis and bilateral cerebral infarction. There was no difference of mild carotid stenosis frequency when comparing ipsilateral, contralateral or bilateral infarct groups (p=0.456). Considering carotids as individual observations, we evaluated 110 carotids, 50 of them presenting mild stenosis, with 27 (54.0%) ipsilateral to stroke and 23 (46.0%) contralateral to cerebral infarction, with no significantly association (p=0.848).
Conclusions: In our sample, assessment of stenosis laterality is not sufficient to suggest an association with stroke, given the large volume of patients with bilateral stenosis. The evaluation of plaque high-risk features by means of exams such as carotid plaque MRI is a resource to be studied.

Palavras Chave

STROKE; ESUS; CAROTID STENOSIS