Prognostic Value of Carotid CEUS in Acute Ischemic Stroke Patients
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Contrast-enhanced ultrasound(CEUS) of carotid artery plaque is a novel method that enabled direct visualization of neovessels in the vulnerable plaque. Plaque enhancement with CEUS showed correlation with the histologic density of neovessels within the carotid plaque and the previous cardiovascular events. Vulnerable plaques with a high risk of thromboembolic complications and rapid progression is associated with acute ischemic stroke. The prognostic value of vulnerable carotid artery plaque depicted with CEUS has not been fully investigated. The purpose of this study is to define prognostic value of plaque enhancement on carotid CEUS in acute stroke patients. Research question is; in acute ischemic stroke patients with ipsilateral carotid plaque as probable etiology of stroke, is the presence of carotid plaque enhancement on CEUS independent predictor of future stroke.
Composite of recurrent stroke, vascular death and myocardial infarction [ Time Frame: 12 months ]
(1) recurrent stroke: newly appeared DWI positive lesion on brain MRI with corresponding neurologic symptom (2) vascular death: sudden death, death due to stroke, myocardial infarction, heart failure, arrhythmia, pulmonary embolism, systemic bleeding, or ischemia of organ. (3) myocardial infarction: at least two of the followings: ① a history of typical angina pain. ② Elevation of Troponin, ③ Newly developed ST change or Q waves or LBBB on ECG (outcomes will be measured by chart review or physician diagnosis or telephone interview)
Secondary Outcome Measures :
Ipsilateral stroke [ Time Frame: 12 months ]
Recurrent stroke of ipsilateral side (recurrent stroke at same side of previous infarction)
All-cause mortality [ Time Frame: 12 months ]
All of the deaths, regardless of the cause
Carotid intervention [ Time Frame: 12 months ]
Ipsilateral carotid endarterectomy or carotid artery stent insertion which was not planned when discharge.
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Layout table for eligibility information
Ages Eligible for Study:
20 Years and older (Adult, Older Adult)
Sexes Eligible for Study:
Accepts Healthy Volunteers:
Hospitalized acute ischemic stroke patients with ipsilateral carotid artery stenosis.
Patients older than 19 years presenting acute ischemic stroke.
Compatible neurologic symptom within 14 days
Compatible MRI finding (one or more positive DWI lesions in the territory of unilateral ICA: ACA or MCA territory) - interpretable MRI image obtained in SNUBH or outside hospital
Etiology of acute ischemic stroke: except cardioembolic stroke (Atrial fibrillation) and other determined etiology
Ipsilateral extracranial carotid artery stenosis on MRA (CE-MRA), CTA or Doppler ultrasound
History of ipsilateral carotid stent or endarterectomy
Carotid intervention during hospital stay
Contraindication to ultrasound contrast agent (SonoVue) A. Right to left, bi-directional, or transient right to left cardiac shunts B. History of hypersensitivity reactions to sulfur hexafluoride lipid microsphere components or any ultrasound contrast agent C. Pregnant or lactating woman D. Unstable cardiopulmonary conditions (acute myocardial infarction, acute coronary artery syndromes, worsening congestive heart failure, or serious ventricular arrhythmias)