TY - JOUR
T1 - Symptomatic non-stenotic carotid disease
T2 - Current challenges and opportunities for diagnosis and treatment
AU - Ospel, Johanna Maria
AU - Kappelhof, Manon
AU - Ganesh, Aravind
AU - Kallmes, David F.
AU - Brinjikji, Waleed
AU - Goyal, Mayank
N1 - Funding Information: JO is a consultant for NICOLab and Chief Scientific Officer of Collavidence. AG has received grants from the Canadian Institutes of Health Research, Canadian Cardiovascular Society, Alberta Innovates, Camps Alberta Neuroscience, Government of Canada – INOVAIT program, Government of Canada – New Frontiers in Research Fund, Microvention, Alzheimer Society of Canada, Heart and Stroke Foundation of Canada, Panmure House. He has also received consulting fees from MD Anlaytics, MyMedicalPanel, Figure 1, CTC Communications Corp, Atheneum, DeepBench, Research on Mind, Creative Research Designs, AlphaSights, 42mr. He has further received honoraria from Figure 1, Alexion, Biogen, Servier Canada and travel support from American Academy of Neurology, Association of Indian Neurologists in America, American Heart Association, University of Calgary. He has patent US 17/317,771 filed. He is member of the editorial board of Neurology:Clinical Practice, Neurology, Stroke, Frontiers in Neurology, and owns stock options in SnapDx, TheRounds.com, Collavidence Inc. DFK holds grants from Cerenovus, Insera Therapeutics, Medtronic, Microvention, Balt, Monarch Biosciences, Brainomix, MiVi, Stryker, and royalties from Medtronic. He holds patents on balloon guide technology, is a data safety monitoring board member of NoNO Inc and Vesalio, holds stock options from Nested Knowledge LLC, Superior Medical Experts LLC, Marblehead Medical LLC, Conway Medical LLC, Monarch Biosciences and is an investor in Piraeus Medical. He uses Brainomix software.WB holds licenses from Medtronic and for a Balloon Guide Catheter Technology, has received consulting fees from Medtronic, Stryker, Imperative Care, Microvention, MIVI Neurovascular, Cerenovus, Asahi, Balt, payments for lectures from Cerenovus and Asahi, patents planned for Balloon Guide Catheter technology and Kyphoplasty technology, is a consulting medical director for MIVI Neurovascular, Chief Medical Officer of Marblehead Medical LLC, Editor in Chief of Interventional Neuroradiology, Board Member of Piraeus Medical, Executive Committee Member of WFITN, and holds stock options of Piraeus Medical, Nested Knowledge, Sonoris Medical, MIVI Neurovascular, Superior Medical Experts. MG holds grants from NoNo Inc, Medtronic, Cerenovus, royalties from GE Healthcare and Microvention, consulting fees from Microvention, Medtronic, Stryker, Mentice, and stock options from Circle Neurovascular. Publisher Copyright: © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023
Y1 - 2023
N2 - Symptomatic non-stenotic carotid plaques (SyNC) are an under-researched and under-recognized source of stroke. Various imaging markers of non-stenotic carotid plaques that are associated with stroke risk have been identified, but these causal relationships need to be confirmed in additional prospective studies. Currently, there exists neither a standardized SyNC definition nor a dedicated set of imaging protocols, although researchers have started to address these shortcomings. Moreover, many neuroradiologists are still unaware of the condition, and hence do not comment on high-risk plaque features other than stenosis in their reports. Regarding SyNC treatment, scant data exist as to whether and to what extent medical, interventional and surgical treatments could influence the course of the disease; the relative lack of data on the € natural' history of untreated SyNC makes treatment comparisons difficult. In our opinion, endovascular SyNC treatment represents the most promising treatment option for SyNC, since it allows for targeted elimination of the embolic source, with few systemic side effects and without the need for general anesthesia. However, currently available carotid devices are designed to treat stenotic lesions, and thus are not optimally designed for SyNC. Developing a device specifically tailored to SyNC could be an important step towards establishing endovascular SyNC treatment in clinical practice. In this review, we provide an overview of the current state of evidence with regard to epidemiological, clinical and imaging features of SyNC, propose a SyNC definition based on imaging and clinical features, and outline a possible pathway towards evidence-based SyNC therapies, with a special focus on endovascular SyNC treatment.
AB - Symptomatic non-stenotic carotid plaques (SyNC) are an under-researched and under-recognized source of stroke. Various imaging markers of non-stenotic carotid plaques that are associated with stroke risk have been identified, but these causal relationships need to be confirmed in additional prospective studies. Currently, there exists neither a standardized SyNC definition nor a dedicated set of imaging protocols, although researchers have started to address these shortcomings. Moreover, many neuroradiologists are still unaware of the condition, and hence do not comment on high-risk plaque features other than stenosis in their reports. Regarding SyNC treatment, scant data exist as to whether and to what extent medical, interventional and surgical treatments could influence the course of the disease; the relative lack of data on the € natural' history of untreated SyNC makes treatment comparisons difficult. In our opinion, endovascular SyNC treatment represents the most promising treatment option for SyNC, since it allows for targeted elimination of the embolic source, with few systemic side effects and without the need for general anesthesia. However, currently available carotid devices are designed to treat stenotic lesions, and thus are not optimally designed for SyNC. Developing a device specifically tailored to SyNC could be an important step towards establishing endovascular SyNC treatment in clinical practice. In this review, we provide an overview of the current state of evidence with regard to epidemiological, clinical and imaging features of SyNC, propose a SyNC definition based on imaging and clinical features, and outline a possible pathway towards evidence-based SyNC therapies, with a special focus on endovascular SyNC treatment.
KW - inflammation
KW - plaque
KW - stenosis
KW - stent
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85160267515&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/jnis-2022-020005
DO - https://doi.org/10.1136/jnis-2022-020005
M3 - Review article
C2 - 37068939
SN - 1759-8478
JO - Journal of NeuroInterventional Surgery
JF - Journal of NeuroInterventional Surgery
M1 - jnis-2022-020005
ER -