Carotid Ultrasound for Assessment of Nonobstructive Carotid Atherosclerosis in Young Adults with Cryptogenic Stroke

Background The role of nonobstructive (<50% stenosis) carotid atherosclerosis (NOCA) in young adults with ischemic stroke is not well understood. In the present study, we investigated the prevalence and the ultrasonic characteristics of NOCA in a consecutive series of young adults with cryptogenic stroke (CS). Methods Patients aged 18-54, consecutively treated in a tertiary hospital for first-ever CS (defined as an ischemic stroke without ASCOD (A: atherosclerosis; S: small-vessel disease; C: cardiac pathology; O: other causes) grade 1 potential cause) in the carotid artery territory, were prospectively enrolled. NOCA was assessed using carotid duplex ultrasonography. Results Of 148 patients with first-ever ischemic stroke, 70 had CS, including 44 patients with carotid CS. NOCA was found in 22 of 44 (50%) patients. All but 1 plaque were echolucent. NOCA was bilateral in 15 patients and unilateral in 7 patients. All unilateral plaques were on the symptomatic side (P = .02). Plaque thickness, plaque length, and plaque volume were greater on the symptomatic side than on the asymptomatic side (P = .001, P < .001, and P < .001, respectively). Discrimination between the symptomatic and the asymptomatic side using any of these plaque metrics was good with areas under the curve (95% confidence interval) of .82 (.69-0.95), .85 (.74-0.96), and .87 (.75-0.99) for plaque thickness, plaque length, and plaque volume, respectively. Conclusions NOCA is frequent in young adults with CS. Measurement of the plaque burden with carotid duplex may help to identify symptomatic NOCA. The role of nonobstructive (<50% stenosis) carotid atherosclerosis (NOCA) in young adults with ischemic stroke is not well understood. In the present study, we investigated the prevalence and the ultrasonic characteristics of NOCA in a consecutive series of young adults with cryptogenic stroke (CS). Patients aged 18-54, consecutively treated in a tertiary hospital for first-ever CS (defined as an ischemic stroke without ASCOD (A: atherosclerosis; S: small-vessel disease; C: cardiac pathology; O: other causes) grade 1 potential cause) in the carotid artery territory, were prospectively enrolled. NOCA was assessed using carotid duplex ultrasonography. Of 148 patients with first-ever ischemic stroke, 70 had CS, including 44 patients with carotid CS. NOCA was found in 22 of 44 (50%) patients. All but 1 plaque were echolucent. NOCA was bilateral in 15 patients and unilateral in 7 patients. All unilateral plaques were on the symptomatic side (P = .02). Plaque thickness, plaque length, and plaque volume were greater on the symptomatic side than on the asymptomatic side (P = .001, P < .001, and P < .001, respectively). Discrimination between the symptomatic and the asymptomatic side using any of these plaque metrics was good with areas under the curve (95% confidence interval) of .82 (.69-0.95), .85 (.74-0.96), and .87 (.75-0.99) for plaque thickness, plaque length, and plaque volume, respectively. NOCA is frequent in young adults with CS. Measurement of the plaque burden with carotid duplex may help to identify symptomatic NOCA.