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ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2025

Prevalence of non-stenotic vulnerable carotid plaques in embolic stroke of undetermined source.

Alessandro Giuricin, Costanza Maria Rapillo, Francesco Arba, Ivano Lombardo, Martina Sperti, Giulia Domna Scrima, Enrico Fainardi, Patrizia Nencini, Mascia Nesi, Cristina Sarti

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Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

10 authors.

Alessandro GiuricinNEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy.
Costanza Maria Rapillo *Stroke Unit, Humanitas Research Hospital, Rozzano Via Manzoni 56, 20089, Rozzano, Italy. rapilloc@gmail.com.ORCID http://orcid.org/0000-0002-6380-6373
Francesco Arba *Stroke Unit, Careggi University Hospital, Florence, Italy.
Ivano LombardoNeuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy.
Martina SpertiNEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy.
Giulia Domna ScrimaNEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy.
Enrico FainardiNeuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy.
Patrizia NenciniStroke Unit, Careggi University Hospital, Florence, Italy.
Mascia Nesi *Stroke Unit, Careggi University Hospital, Florence, Italy.
Cristina Sarti *NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThe latest research in ischaemic stroke pathogenesis is directed to unveil what is inside embolic stroke of undetermined source (ESUS). Whether vulnerable non stenotic carotid plaques (NSTEPS), i.e. atherosclerotic lesions in carotid arteries determining a stenosis lower than 50%, may represent a cause of stroke in ESUS is a matter of debate. We aimed to study the prevalence of NSTEPS in an ESUS population. PATIENTS AND

methodsWe retrospectively identified a consecutive ESUS population admitted to the Stroke-Unit of Careggi Hospital, Italy from 2019 to 2022. Characteristics of atherosclerotic plaques (thickness, ulceration, hypodensity) and their location (ipsilateral versus contralateral to the stroke) were studied on carotid CT angiography (CTA). Follow-up data were recorded up to 24 months after stroke.

resultsWe identified 57 ESUS patients with unilateral ischaemic lesions studied with CTA; 53 (93%) had an ipsilateral carotid plaque, 81% contralateral, (p = 0.754) and 74% both. Plaques ipsilateral to stroke were ≥ 3 mm thick in 15 (28%) patients; hypodense in 14 (26%) and ulcerated in 5 (9%). The frequency of hypodensity was higher in ipsilateral compared to contralateral plaques (26% vs. 13%, p = 0.039) and ulceration was around four times more frequent, although not statistically significant (9% vs. 2%, p = 0.219). At follow-up, six patients had stroke recurrence (11%), 2 of them were in the same vascular territory of the former. DISCUSSION AND

conclusionsOur data suggest that plaques ipsilateral to stroke seem to be more frequently vulnerable and consequently more prone to embolization. Prospective data are needed to clarify the causal role of NSTEPS in ESUS.

Indexed as

Embolic StrokePlaque, AtheroscleroticAgedAged, 80 and overCarotid Artery DiseasesComputed Tomography AngiographyFemaleHumansItalyMaleMiddle AgedPrevalenceRetrospective StudiesAtherosclerosisComplicatedEmbolic strokeNon-stenotic plaqueStroke of undetermined source

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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.