ParisK: Validation of Imaging Techniques
ParisK: Validation of Imaging Techniques
The possibility of the identification of the risk of rupture of a carotid plaque will have
 tremendous impact in clinical decision making. Firstly, in symptomatic patients with a 30-69%
 stenosis, who are currently not operated upon according to the current guidelines,
 identification of the risk of rupture plaque could identify patients who have a high risk of
 recurrent stroke, and would benefit of carotid intervention, such as endarterectomy or stent
 placement. This could potentially prevent a substantial number of strokes. Secondly, in all
 symptomatic patients with a 70-99% stenosis carotid intervention should be considered,
 according to the guidelines. However, only one out of six patients with a 70-99% stenosis
 benefits from a carotid intervention. Identification of patients with a high risk of a
 recurrent stroke would reduce the number of unnecessary interventions substantially.

 The main objective is to show whether imaging characteristics assessed at baseline can
 predict clinical events in patients with a 30-69 % symptomatic carotid stenosis.
Inclusion Criteria:

 -  neurological symptoms due to ischemia in the carotid artery territory as diagnosed by
 their neurologist based on anamneses, physical examination and brain imaging (CT or
 MRI)

 -  carotid artery stenosis < 70% (upper cut-off value is based on the NASCET criteria,
 the lower cut-off value is an atherosclerotic plaque with a thickness of at least 2-3
 mm, which corresponds to an ECST stenosis of 30%

 -  written informed consent

 Exclusion Criteria:

 -  patients with 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

 -  patients who have a documented allergy to MRI or CT contrast media

 -  patients with renal clearance < 30 ml/minute are not eligible to undergo
 contrast-enhanced MRI

 -  patients with renal clearance < 60 ml/minute are not eligible to undergo MDCT

 -  patients who had a TIA or minor stroke more than 3 months before inclusion