Evidence map›Paper›PMID 27412144›Full record

Observational studyNeurology2016

Nonstenotic carotid plaque on CT angiography in patients with cryptogenic stroke.

Jonathan M Coutinho, Sheldon Derkatch, Alphonse R J Potvin, George Tomlinson, Tim-Rasmus Kiehl, Frank L Silver, Daniel M Mandell

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Neurology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 62 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
62citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

62 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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  17. Prevalence of non-stenotic vulnerable carotid plaques in embolic stroke of undetermined source.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025
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  19. The role of non-stenosing carotid artery plaques in embolic stroke of undetermined source, is it a silent offender? A review of literature.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2024
    Review
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2 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Jonathan M CoutinhoFrom the Division of Neuroradiology, Department of Medical Imaging (J.M.C., S.D., D.M.M.), Division of Neurology, Department of Medicine (A.R.J.P., F.L.S.), and Department of Pathology (T.-R.K.), University Health Network and the University of Toronto; Dalla Lana School of Public Health (G.T.), University of Toronto; and Department of Medicine (G.T.), University Health Network and Mount Sinai Hospital, Toronto, Canada.
Sheldon DerkatchFrom the Division of Neuroradiology, Department of Medical Imaging (J.M.C., S.D., D.M.M.), Division of Neurology, Department of Medicine (A.R.J.P., F.L.S.), and Department of Pathology (T.-R.K.), University Health Network and the University of Toronto; Dalla Lana School of Public Health (G.T.), University of Toronto; and Department of Medicine (G.T.), University Health Network and Mount Sinai Hospital, Toronto, Canada.
Alphonse R J PotvinFrom the Division of Neuroradiology, Department of Medical Imaging (J.M.C., S.D., D.M.M.), Division of Neurology, Department of Medicine (A.R.J.P., F.L.S.), and Department of Pathology (T.-R.K.), University Health Network and the University of Toronto; Dalla Lana School of Public Health (G.T.), University of Toronto; and Department of Medicine (G.T.), University Health Network and Mount Sinai Hospital, Toronto, Canada.
George TomlinsonFrom the Division of Neuroradiology, Department of Medical Imaging (J.M.C., S.D., D.M.M.), Division of Neurology, Department of Medicine (A.R.J.P., F.L.S.), and Department of Pathology (T.-R.K.), University Health Network and the University of Toronto; Dalla Lana School of Public Health (G.T.), University of Toronto; and Department of Medicine (G.T.), University Health Network and Mount Sinai Hospital, Toronto, Canada.
Tim-Rasmus KiehlFrom the Division of Neuroradiology, Department of Medical Imaging (J.M.C., S.D., D.M.M.), Division of Neurology, Department of Medicine (A.R.J.P., F.L.S.), and Department of Pathology (T.-R.K.), University Health Network and the University of Toronto; Dalla Lana School of Public Health (G.T.), University of Toronto; and Department of Medicine (G.T.), University Health Network and Mount Sinai Hospital, Toronto, Canada.
Frank L SilverFrom the Division of Neuroradiology, Department of Medical Imaging (J.M.C., S.D., D.M.M.), Division of Neurology, Department of Medicine (A.R.J.P., F.L.S.), and Department of Pathology (T.-R.K.), University Health Network and the University of Toronto; Dalla Lana School of Public Health (G.T.), University of Toronto; and Department of Medicine (G.T.), University Health Network and Mount Sinai Hospital, Toronto, Canada.
Daniel M MandellFrom the Division of Neuroradiology, Department of Medical Imaging (J.M.C., S.D., D.M.M.), Division of Neurology, Department of Medicine (A.R.J.P., F.L.S.), and Department of Pathology (T.-R.K.), University Health Network and the University of Toronto; Dalla Lana School of Public Health (G.T.), University of Toronto; and Department of Medicine (G.T.), University Health Network and Mount Sinai Hospital, Toronto, Canada. danny.mandell@uhn.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo determine whether large (≥3 mm thick) but nonstenotic (<50%) carotid artery atherosclerotic plaque predominantly occurs ipsilateral rather than contralateral to cryptogenic stroke.

methodsThis was a cross-sectional observational study. Using a stroke registry, we identified consecutive patients with anterior circulation embolic stroke of undetermined source (ESUS). Using CT angiography, we measured carotid plaque size (thickness, mm) and carotid artery stenosis (North American Symptomatic Carotid Endarterectomy Trial method) for each patient. We dichotomized plaque size at several predefined thresholds and calculated the frequency of plaque size above each threshold ipsilateral vs contralateral to stroke.

resultsWe included 85 patients with ESUS. Plaque with thickness ≥5 mm was present ipsilateral to stroke in 11% of patients, and contralateral in 1% (9/85 vs 1/85; p = 0.008). Plaque with thickness ≥4 mm was present ipsilateral to stroke in 19% of patients, and contralateral in 5% (16/85 vs 4/85; p = 0.002). Plaque with thickness ≥3 mm was present ipsilateral to stroke in 35% of patients, and contralateral in 15% (30/85 vs 13/85; p = 0.001). There was no difference in percentage stenosis ipsilateral vs contralateral to stroke (p = 0.98), and weak correlation between plaque size and stenosis (R(2) = 0.26, p < 0.001).

conclusionsLarge but nonstenotic carotid artery plaque is considerably more common ipsilateral than contralateral to cryptogenic stroke, suggesting that nonstenotic plaque is an underrecognized cause of stroke. We measured plaque size using CT angiography, a method that could be easily implemented in clinical practice.

Indexed as

RegistriesAgedCarotid Artery DiseasesCarotid StenosisComputed Tomography AngiographyCross-Sectional StudiesFemaleHumansMaleMiddle AgedPlaque, AtheroscleroticStroke

Identifiers

PMID27412144
PMCPMC4999163

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.