For a study, researchers sought to determine if complex carotid artery plaques (CAP) ipsilateral to acute ischemic anterior circulation stroke (icCAP) were linked to recurrent ischemic stroke or transient ischemic attack (TIA).

The multicenter CAPIAS (Carotid Plaque Imaging in Acute Stroke) research enrolled patients with ischemic stroke limited to the region of a single carotid artery. Multisequence, contrast-enhanced carotid magnetic resonance imaging conducted within 10 days of stroke onset characterized complicated (AHA-lesion type VI) CAP. After 3, 12, 24, and 36 months, recurrent incidents were evaluated. The primary outcome was recurrent ischemic stroke or transient ischemic attack (TIA). 

About 104 of the 196 patients recruited experienced a cryptogenic stroke and nonstenosing CAP. Recurrent ischemic stroke or TIA occurred in 21 individuals over a 30-month average follow-up period. Recurrent events were significantly more common in icCAP patients than in non-icCAP patients, both in the overall cohort (incidence rate [3-year interval]: 9.50 vs. 3.61 per 100 patient-years; P=0.025, log-rank test) and in patients with cryptogenic stroke (10.92 vs. 1.82 per 100 patient-years; P=0.003). Ipsilateral events drove the outcomes. In patients with cryptogenic stroke, a ruptured fibrous cap (HR: 4.91; 95% CI: 1.31-18.45; P=0.018) and intraplaque hemorrhage (HR: 4.37; 95% CI: 1.20-15.97; P=0.026) were associated with a significantly elevated risk of recurrent episodes.

A complicated CAP ipsilateral to an acute ischemic anterior circulation stroke has been linked to an elevated risk of recurrent ischemic stroke or TIA. Carotid plaque imaging identifies high-risk patients who may be appropriate for future secondary prevention trials.