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Randomized Controlled Trial
. 2021 Sep;30(9):105940.
doi: 10.1016/j.jstrokecerebrovasdis.2021.105940. Epub 2021 Jul 24.

Contralateral Stenosis and Echolucent Plaque Morphology are Associated with Elevated Stroke Risk in Patients Treated with Asymptomatic Carotid Artery Stenosis within a Controlled Clinical Trial (SPACE-2)

Tilman Reiff  1 , Hans-Henning Eckstein  2 , Ulrich Mansmann  3 , Olav Jansen  4 , Gustav Fraedrich  5 , Harald Mudra  6 , Dittmar Böckler  7 , Michael Böhm  8 , Hartmut Brückmann  9 , E Sebastian Debus  10 , Jens Fiehler  11 , Klaus Mathias  12 , E Bernd Ringelstein  13 , Jürg Schmidli  14 , Robert Stingele  15 , Ralf Zahn  16 , Thomas Zeller  17 , Wolf-Dirk Niesen  18 , Kristian Barlinn  19 , Andreas Binder  20 , Jörg Glahn  21 , Peter Arthur Ringleb  22 ; SPACE-2 Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Contralateral Stenosis and Echolucent Plaque Morphology are Associated with Elevated Stroke Risk in Patients Treated with Asymptomatic Carotid Artery Stenosis within a Controlled Clinical Trial (SPACE-2)

Tilman Reiff et al. J Stroke Cerebrovasc Dis. 2021 Sep.

Abstract

Background: Asymptomatic carotid artery stenosis (ACS) has a low risk of stroke. To achieve an advantage over noninterventional best medical treatment (BMT), carotid endarterectomy (CEA) or carotid artery stenting (CAS) must be performed with the lowest possible risk of stroke. Therefore, an analysis of risk-elevating factors is essential. Grade of ipsilateral and contralateral stenosis as well as plaque morphology are known risk factors in ACS.

Methods: The randomized, controlled, multicenter SPACE-2 trial had to be stopped prematurely after recruiting 513 patients. 203 patients were randomized to CEA, 197 to CAS, and 113 to BMT. Within one year, risk factors such as grade of stenosis and plaque morphology were analyzed.

Results: Grade of contralateral stenosis (GCS) was higher in patients with any stroke (50%ECST vs. 20%ECST; p=0.012). Echolucent plaque morphology was associated with any stroke on the day of intervention (OR 5.23; p=0.041). In the periprocedural period, any stroke was correlated with GCS in the CEA group (70%ECST vs. 20%ECST; p=0.026) and with echolucent plaque morphology in the CAS group (6% vs. 1%; p=0.048). In multivariate analysis, occlusion of the contralateral carotid artery (CCO) was associated with risk of any stroke (OR 7.00; p=0.006), without heterogeneity between CEA and CAS.

Conclusion: In patients with asymptomatic carotid artery stenosis, GCS, CCO, as well as echolucent plaque morphology were associated with a higher risk of cerebrovascular events. The risk of stroke in the periprocedural period was increased by GCS in CEA and by echolucent plaque in CAS. Due to small sample size, results must be interpreted carefully.

Keywords: Asymptomatic carotid artery stenosis; Best Medical Treatment; Carotid Artery Stenting; Carotid Endarterectomy; Contralateral stenosis; Echolucent Plaque.

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Conflict of interest statement

Declaration of Competing Interest All authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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