Predictive Value for Stroke
Predictive Value for Stroke
Patients with a moderate to severe carotid atherosclerotic plaque are at risk for stroke and
 this risk increases with increasing degree of stenosis. It has been shown that carotid
 endarterectomy in symptomatic patients with a carotid artery stenosis of 70-99% is highly
 beneficial. However, the beneficial effect of surgery in patients with symptomatic 30-69%
 stenosis is not clear yet.A clear beneficial effect of surgery in the 30-69% stenosis group
 might be found in a sub-group of patients whom are at greater risk for stroke. Definition of
 this sub-group might be achieved by plaque characterization, since rupture of a vulnerable
 plaque is the main cause of stroke due to carotid artery stenosis.This study will include
 patients with a 30-69% carotid artery stenosis, and assess plaque composition by MRI, the
 degree of plaque inflammation by FDG-PET, and the amount of microembolization by transcranial
 Doppler ultrasound. The main purpose of this study is to assess whether one or a combination
 of each of these imaging methods can predict the occurrence of a (recurrent) ischemic stroke.
Inclusion Criteria:

 -  Patients with neurological symptoms due to ischemia in the carotid artery territory
 and with a carotid stenosis between 30% and 69% as detected by ultrasound examination

 Exclusion Criteria:

 -  Patients with a probable cardiac source of embolism (rhythm disorders, mitral valve
 stenosis, prolapse or calcification, mechanical cardiac valves, recent myocardial
 infarction, left ventricular thrombus, atrial myxoma, endocarditis, dilated
 cardiomyopathy, patent foramen ovale) or a clotting disorder.

 -  Patients with evident other cause of neurological symptoms than carotid stenosis due
 to atherosclerotic disease (like demyelinating diseases, epilepsy, congenital brain
 disorders, aneurysms, fibromuscular dysplasia, etc.).

 -  Patients already scheduled for carotid endarterectomy or stenting

 -  Severe co-morbidity, dementia, or pregnancy.

 -  Standard contra-indications for MRI (ferromagnetic implants like pacemakers or other
 electronic implants, metallic eye fragments, vascular clips, claustrophobia,
 documented allergy to contrast media, renal insufficiency, etc).

 -  Patients who were referred from another hospital to one of the three participating
 hospitals (to avoid referral bias).

 -  Patients who had a TIA or minor stroke more than 3 weeks before inclusion

 -  Patients who had a prior TIA or stroke