ABCD2 risk score does not predict the presence of cerebral microemboli in patients with hyper-acute symptomatic critical carotid artery stenosis
| Autor: | Donald R. J. Singer, Christopher H.E. Imray, Charles E. Hutchinson, Mahmud Saedon |
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| Rok vydání: | 2017 |
| Předmět: |
Platelets
Male medicine.medical_specialty Time Factors microemboli Ultrasonography Doppler Transcranial medicine.medical_treatment Clinical Decision-Making Carotid endarterectomy 030204 cardiovascular system & hematology Risk Assessment 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Risk Factors Clinical Decision Rules medicine ABCD2 Humans Carotid Stenosis In patient Prospective Studies Registries Stroke Aged Ischemic Stroke Framingham Risk Score Receiver operating characteristic biology business.industry Prognosis medicine.disease Transcranial Doppler Stenosis Intracranial Embolism Ischemic Attack Transient transcranial doppler biology.protein Original Article Female Neurology (clinical) Radiology Triage Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery |
| Zdroj: | Stroke and Vascular Neurology |
| ISSN: | 2059-8696 2059-8688 |
| DOI: | 10.1136/svn-2017-000073 |
| Popis: | IntroductionABCD2 risk score and cerebral microemboli detected by transcranial Doppler (TCD) have been separately shown to the predict risk of recurrent acute stroke. We studied whether ABCD2 risk score predicts cerebral microemboli in patients with hyper-acute symptomatic carotid artery stenosis.Participants and methodsWe studied 206 patients presenting within 2 weeks of transient ischaemic attack or minor stroke and found to have critical carotid artery stenosis (≥50%). 86 patients (age 70±1 (SEM: years), 58 men, 83 Caucasian) had evidence of microemboli; 72 (84%) of these underwent carotid endarterectomy (CEA). 120 patients (age 72±1 years, 91 men, 113 Caucasian) did not have microemboli detected; 102 (85%) of these underwent CEA. Data were analysed using X2 and Mann–Whitney U tests and receiver operating characteristic (ROC) curves.Results140/206 (68%: 95% CI 61.63 to 74.37) patients with hyper-acute symptomatic critical carotid stenosis had an ABCD2 risk score ≥4. There was no significant difference in the NICE red flag criterion for early assessment (ABCD2 risk score ≥4) for patients with cerebral microemboli versus those without microemboli (59/86 vs 81/120 patients: OR 1.05 ABCD2 risk score ≥4 (95% CI 0.58 to 1.90, p=0.867)). The ABCD2 risk score was 2 risk score showed no prediction of cerebral microemboli (no pre-event APT, n=57: AUC 0.45 (95% CI 0.29 to 0.60, p=0.531); pre-event APT, n=147: AUC 0.51 (95% CI 0.42 to 0.60, p=0.804)).ConclusionsThe ABCD2 score did not predict the presence of cerebral microemboli or carotid disease in over one-quarter of patients with symptomatic critical carotid artery stenosis. On the basis of NICE guidelines (refer early if ABCD2 ≥4), assessment of high stroke risk based on ABCD2 scoring may lead to inappropriate delay in urgent treatment in many patients. |
| Databáze: | OpenAIRE |
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