Non-stenotic Carotid Plaques in Embolic Stroke of Unknown Source
Embolic stroke of unknown source (ESUS) represents one in five ischemic strokes. Ipsilateral non-stenotic carotid plaques are identified in 40% of all ESUS. In this narrative review, we summarize the evidence supporting the potential causal relationship between ESUS and non-stenotic carotid plaques;...
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2021-09-01
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doaj-872b79d9c6ec468d8c6b37daff7bc7d32021-09-22T05:23:59ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-09-011210.3389/fneur.2021.719329719329Non-stenotic Carotid Plaques in Embolic Stroke of Unknown SourceJoseph Kamtchum-Tatuene0Ali Z. Nomani1Sarina Falcione2Danielle Munsterman3Gina Sykes4Twinkle Joy5Elena Spronk6Maria Isabel Vargas7Glen C. Jickling8Faculty of Medicine and Dentistry, Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, CanadaDepartment of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, CanadaDepartment of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, CanadaDepartment of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, CanadaDepartment of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, CanadaDepartment of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, CanadaDepartment of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, CanadaDivision of Neuroradiology, Department of Radiology and Medical Imaging, Geneva University Hospital, Geneva, SwitzerlandDepartment of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, CanadaEmbolic stroke of unknown source (ESUS) represents one in five ischemic strokes. Ipsilateral non-stenotic carotid plaques are identified in 40% of all ESUS. In this narrative review, we summarize the evidence supporting the potential causal relationship between ESUS and non-stenotic carotid plaques; discuss the remaining challenges in establishing the causal link between non-stenotic plaques and ESUS and describe biomarkers of potential interest for future research. In support of the causal relationship between ESUS and non-stenotic carotid plaques, studies have shown that plaques with high-risk features are five times more prevalent in the ipsilateral vs. the contralateral carotid and there is a lower incidence of atrial fibrillation during follow-up in patients with ipsilateral non-stenotic carotid plaques. However, non-stenotic carotid plaques with or without high-risk features often coexist with other potential etiologies of stroke, notably atrial fibrillation (8.5%), intracranial atherosclerosis (8.4%), patent foramen ovale (5–9%), and atrial cardiopathy (2.4%). Such puzzling clinical associations make it challenging to confirm the causal link between non-stenotic plaques and ESUS. There are several ongoing studies exploring whether select protein and RNA biomarkers of plaque progression or vulnerability could facilitate the reclassification of some ESUS as large vessel strokes or help to optimize secondary prevention strategies.https://www.frontiersin.org/articles/10.3389/fneur.2021.719329/fullstrokecarotid stenosiscarotid plaquebiomarkersatherosclerosis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Joseph Kamtchum-Tatuene Ali Z. Nomani Sarina Falcione Danielle Munsterman Gina Sykes Twinkle Joy Elena Spronk Maria Isabel Vargas Glen C. Jickling |
spellingShingle |
Joseph Kamtchum-Tatuene Ali Z. Nomani Sarina Falcione Danielle Munsterman Gina Sykes Twinkle Joy Elena Spronk Maria Isabel Vargas Glen C. Jickling Non-stenotic Carotid Plaques in Embolic Stroke of Unknown Source Frontiers in Neurology stroke carotid stenosis carotid plaque biomarkers atherosclerosis |
author_facet |
Joseph Kamtchum-Tatuene Ali Z. Nomani Sarina Falcione Danielle Munsterman Gina Sykes Twinkle Joy Elena Spronk Maria Isabel Vargas Glen C. Jickling |
author_sort |
Joseph Kamtchum-Tatuene |
title |
Non-stenotic Carotid Plaques in Embolic Stroke of Unknown Source |
title_short |
Non-stenotic Carotid Plaques in Embolic Stroke of Unknown Source |
title_full |
Non-stenotic Carotid Plaques in Embolic Stroke of Unknown Source |
title_fullStr |
Non-stenotic Carotid Plaques in Embolic Stroke of Unknown Source |
title_full_unstemmed |
Non-stenotic Carotid Plaques in Embolic Stroke of Unknown Source |
title_sort |
non-stenotic carotid plaques in embolic stroke of unknown source |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Neurology |
issn |
1664-2295 |
publishDate |
2021-09-01 |
description |
Embolic stroke of unknown source (ESUS) represents one in five ischemic strokes. Ipsilateral non-stenotic carotid plaques are identified in 40% of all ESUS. In this narrative review, we summarize the evidence supporting the potential causal relationship between ESUS and non-stenotic carotid plaques; discuss the remaining challenges in establishing the causal link between non-stenotic plaques and ESUS and describe biomarkers of potential interest for future research. In support of the causal relationship between ESUS and non-stenotic carotid plaques, studies have shown that plaques with high-risk features are five times more prevalent in the ipsilateral vs. the contralateral carotid and there is a lower incidence of atrial fibrillation during follow-up in patients with ipsilateral non-stenotic carotid plaques. However, non-stenotic carotid plaques with or without high-risk features often coexist with other potential etiologies of stroke, notably atrial fibrillation (8.5%), intracranial atherosclerosis (8.4%), patent foramen ovale (5–9%), and atrial cardiopathy (2.4%). Such puzzling clinical associations make it challenging to confirm the causal link between non-stenotic plaques and ESUS. There are several ongoing studies exploring whether select protein and RNA biomarkers of plaque progression or vulnerability could facilitate the reclassification of some ESUS as large vessel strokes or help to optimize secondary prevention strategies. |
topic |
stroke carotid stenosis carotid plaque biomarkers atherosclerosis |
url |
https://www.frontiersin.org/articles/10.3389/fneur.2021.719329/full |
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