Andrew N. Nicolaides, MS, FRCS, PhD (Hon), Stavros K

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Presentation transcript:

Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification Andrew N. Nicolaides, MS, FRCS, PhD (Hon), Stavros K. Kakkos, MD, MSc, PhD, DIC, Efthyvoulos Kyriacou, BSc, PhD, Maura Griffin, MSc, DIC, PhD, Michael Sabetai, MD, FRCS, PhD, Dafydd J. Thomas, MD, PhD, Thomas Tegos, MD, PhD, George Geroulakos, MD, PhD, Nicos Labropoulos, PhD, DIC, RVT, Caroline J. Doré, BSc, Tim P. Morris, MSc, Ross Naylor, MD, FRCS, Anne L. Abbott, MB, BS, FRACP, PhD Journal of Vascular Surgery Volume 52, Issue 6, Pages 1486-1496.e5 (December 2010) DOI: 10.1016/j.jvs.2010.07.021 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 Kaplan-Meier plots showing ipsilateral cerebrovascular or retinal ischemic (CORI) event-free survival stratified by: (A) European Carotid Surgery Trial (ECST) stenosis: log-rank test: P for trend = .002; (B) grayscale median (GSM): log-rank test: P for trend < .0001; (C) plaque area (mm2): log-rank test: P for trend < .0001; (D) discrete white areas (DWA): log-rank test: P < .0001; (E) history of contralateral transient ischemic attacks (TIAs) or stroke: log-rank test: P < .0001. Journal of Vascular Surgery 2010 52, 1486-1496.e5DOI: (10.1016/j.jvs.2010.07.021) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 Receiver operating characteristic (ROC) curves (A) for cerebrovascular or retinal ischemic (CORI) events using (a) stenosis as continuous variable, (b) the linear predictor score from the proportional hazards model (model i) that included stenosis and significant clinical features only (pack-years, history of contralateral transient ischemic attacks [TIAs] or stroke), and (c) the proportional hazards model (model ii) that included stenosis, significant clinical and plaque characteristics (grayscale median [GSM], plaque area, discrete white areas [DWAs], and history of contralateral TIAs or stroke) for predicting ipsilateral CORI events. Corresponding areas under curve are (a) 0.59 (95% confidence interval [CI], 0.54-0.64), (b) 0.66 (95% CI, 0.62-0.72), and (c) 0.82 (95% CI, 0.78-0.86). P < .003 for all pairwise comparisons. ROC curve for stroke (B) using the linear predictor score of the proportional hazards model (model iii). Area under curve is 0.80 (95% CI, 0.74-0.86). Journal of Vascular Surgery 2010 52, 1486-1496.e5DOI: (10.1016/j.jvs.2010.07.021) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 Calibration plot for model (iii), based on all 1121 patients (– – – shows the line of perfect agreement between predicted and observed 5-year stroke risk). Journal of Vascular Surgery 2010 52, 1486-1496.e5DOI: (10.1016/j.jvs.2010.07.021) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 For image normalization a sample of “blood” free of noise and a sample from the inner two-fourths of the brightest part of the adventitia adjacent to the plaque are obtained. Journal of Vascular Surgery 2010 52, 1486-1496.e5DOI: (10.1016/j.jvs.2010.07.021) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 Examples of normalized grayscale and color contoured images of “cut” plaques. (A) Type 1, GSM 2, DWA absent; (B) Type 2, GSM 18, DWA present; (C) Type 3, GSM 28, DWA present; (D) Type 4, GSM 98, DWA n/a. Journal of Vascular Surgery 2010 52, 1486-1496.e5DOI: (10.1016/j.jvs.2010.07.021) Copyright © 2010 Society for Vascular Surgery Terms and Conditions