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MDCT angiography may help risk-stratify patients in danger of stroke

MDCT angiography can aid in risk assessment based on plaque vulnerability, a finding that would be valuable in deciding how to manage carotid artery stenosis (a narrowing of the carotid artery that can lead to stroke) that shows no symptoms, says a new study by researchers from the University of Virginia Health Sciences in Charlottesville, VA.

Using MDCT angiography on 31 patients with greater than 60% narrowing of the carotid artery by plaque build-up, the researchers found that carotid artery calcified plaques outside of the cranium that cause the narrowing show symptoms less often and may be more stable than noncalcified plaques. According to the study, this finding can help determine the best way to proceed in treating patients with asymptomatic carotid artery stenosis.

Kiran R. Nandalur, MD, lead author of the study, said that the management of asymptomatic carotid artery stenosis is controversial. Although the American Stroke Association recommends surgical removal of the inner lining of the carotid artery for patients with greater than 60% stenosis, international practice varies widely because of perceived high surgical risks, new medications, and less convincing data from Europe. "If these patients could be risk-stratified according to their likelihood of developing symptoms based on plaque morphology, low-risk patients could avoid the dangers of surgery and be treated medically and high-risk patients could be treated more aggressively," said Dr. Nandalur.

According to the study, these results may also have implications for interpreting calcification of plaque in other vascular beds, such as in coronary arteries. "If calcified plaques are less prone to disruption and less likely to lead to events caused by restricted blood flow as in the carotids in our study, patients with high-grade stenosis of the coronaries, and possibly even moderate stenosis, could be treated less aggressively," said Dr. Nandalur.

Dr. Nandalur will pre
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Contact: Jason Ocker
jason@arrs.org
703-858-4304
American Roentgen Ray Society
3-May-2004


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