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Review
. 2020 Oct;8(19):1271.
doi: 10.21037/atm.2020.02.156.

Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) study: what have we learned from it?

Kosmas I Paraskevas  1 , Andrew N Nicolaides  2 , Stavros K Kakkos  3
Affiliations
Review

Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) study: what have we learned from it?

Kosmas I Paraskevas et al. Ann Transl Med. 2020 Oct.

Abstract

The Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) study is the largest natural history study on patients with 50-99% asymptomatic carotid stenosis (ACS). It included 1,121 ACS individuals with a follow-up between 6 and 96 months (mean: 48 months). During the last 15 years, several important ACSRS substudies have been published that have contributed significantly to the optimal management of ACS patients. These studies have demonstrated that specific baseline clinical characteristics and ultrasonic plaque features after image normalization (namely carotid plaque type, gray scale median, carotid plaque area, juxtaluminal black area without a visible echogenic cup, discrete white areas in an echolucent part of a plaque, silent embolic infarcts on brain computed tomography scans, a history of contralateral transient ischemic attacks/strokes) can independently predict future ipsilateral cerebrovascular events. The ACSRS study provided proof that by use of a computer program to normalize plaque images and extract plaque texture features, a combination of features can stratify patients into various categories depending on their stroke risk. The present review will discuss the various reported predictors of future ipsilateral cerebrovascular events and how these characteristics can be used to calculate individual stroke risk.

Keywords: Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS); Asymptomatic carotid stenosis (ACS); carotid endarterectomy (CEA); stroke risk.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm.2020.02.156). ANN has shares in LifeQ Medical Ltd. The other authors have no conflicts of interest to declare.

References

    1. Nicolaides A, Sabetai M, Kakkos SK, et al. ACSRS Study Group . The Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) study. Aims and results of quality control. Int Angiol 2003;22:263-72. - PubMed
    1. Nicolaides AN. Asymptomatic carotid stenosis and risk of stroke. Identification of a high risk group (ACSRS). A natural history study. Int Angiol 1995;14:21-3. - PubMed
    1. Kyriacou EC, Petroudi S, Pattichis CS, et al. Prediction of high-risk asymptomatic carotid plaques based on ultrasonic image features. IEEE Trans Inf Technol Biomed 2012;16:966-73. 10.1109/TITB.2012.2192446 - DOI - PubMed
    1. Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA 1995;273:1421-8. 10.1001/jama.1995.03520420037035 - DOI - PubMed
    1. Nicolaides AN, Kakkos S, Griffin M, et al. Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) Study Group . Severity of asymptomatic carotid stenosis and risk of ipsilateral hemispheric ischaemic events: results from the ACSRS study. Eur J Vasc Endovasc Surg 2005;30:275-84. 10.1016/j.ejvs.2005.04.031 - DOI - PubMed