Symptomatic Carotid Atheroma Inflammation Lumen-stenosis score compared with Oxford and Essen risk scores to predict recurrent stroke in symptomatic carotid stenosis
Gorey, Sarah E. (University College Dublin (Dublí, Irlanda))
McCabe, John Joseph (Mater Misericordiae University Hospital (Dublín, Irlanda))
Camps-Renom, Pol (Institut d'Investigació Biomèdica Sant Pau)
Giannotti, Nicola (University of Sydney (Sydney, Austràlia))
McNulty, Jonathan (University College Dublin (Dublí, Irlanda))
Barry, Mary Claire (St Vincent's University Hospital (Dublí, Irlanda))
Cassidy, Timothy P. (St Vincent's University Hospital (Dublí, Irlanda))
Cronin, Simon J. (University College Cork (Cork, Irlanda))
Dolan, Eamon (James Connolly Memorial Hospital (Dublí, Irlanda))
Fernández-León, Alejandro (Institut d'Investigació Biomèdica Sant Pau)
Foley, SJ. (University College Dublin (Dublí, Irlanda))
Harbison, Joseph (St James' Hospital (Dublí, Irlanda))
O'Connell, Martin J. (Mater Misericordiae University Hospital (Dublín, Irlanda))
Williams, David (University of Medicine and Health Sciences (Dublín, Irlanda))
Marnane, Michael (Mater Misericordiae University Hospital (Dublín, Irlanda))
Martí-Fàbregas, Joan (Institut d'Investigació Biomèdica Sant Pau)
Kelly, Peter J. (Mater Misericordiae University Hospital (Dublín, Irlanda))
Universitat Autònoma de Barcelona

Data:	2023
Resum:	The Oxford Carotid Stenosis tool (OCST) and Essen Stroke Risk Score (ESRS) are validated to predict recurrent stroke in patients with and without carotid stenosis. The Symptomatic Carotid Atheroma Inflammation Lumen stenosis (SCAIL) score combines stenosis and plaque inflammation on fluorodeoxyglucose positron-emission tomography (FDG-PET). We compared SCAIL with OCST and ESRS to predict ipsilateral stroke recurrence in symptomatic carotid stenosis. We pooled three prospective cohort studies of patients with recent (<30 days) non-severe ischaemic stroke/TIA and internal carotid artery stenosis (>50%). All patients had carotid FDG-PET/CT angiography and late follow-up, with censoring at carotid revascularisation. Of 212 included patients, 16 post-PET ipsilateral recurrent strokes occurred in 343 patient-years follow-up (median 42 days (IQR 13-815)). Baseline SCAIL predicted recurrent stroke (unadjusted hazard ratio [HR] 1. 96, CI 1. 20-3. 22, p = 0. 007, adjusted HR 2. 37, CI 1. 31-4. 29, p = 0. 004). The HR for OCST was 0. 996 (CI 0. 987-1. 006, p = 0. 49) and for ESRS was 1. 26 (CI 0. 87-1. 82, p = 0. 23) (all per 1-point score increase). C-statistics were: SCAIL 0. 66 (CI 0. 51-0. 80), OCST 0. 52 (CI 0. 40-0. 64), ESRS 0. 61 (CI 0. 48-0. 74). Compared with ESRS, addition of plaque inflammation (SUV) to ESRS improved risk prediction when analysed continuously (HR 1. 51, CI 1. 05-2. 16, p = 0. 03) and categorically (p = 0. 005 for risk increase across groups; HR 3. 31, CI 1. 42-7. 72, p = 0. 006; net reclassification improvement 10%). Findings were unchanged by further addition of carotid stenosis. SCAIL predicted recurrent stroke, had discrimination better than chance, and improved the prognostic utility of ESRS, suggesting that measuring plaque inflammation may improve risk stratification in carotid stenosis.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Atherosclerosis ; Carotid stenosis ; Inflammation ; Prediction ; Recurrent stroke ; Vascular inflammation
Publicat a:	European Stroke Journal, Vol. 8 Núm. 4 (december 2023) , p. 1064-1070, ISSN 2396-9881

DOI: 10.1177/23969873231186911
PMID: 37480278

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