July 12, 2022; 99 (2) Research Article
Association of Plaque Inflammation With Stroke Recurrence in Patients With Unproven Benefit From Carotid Revascularization
View ORCID ProfilePol Camps-Renom, John McCabe, View ORCID ProfileJoan Martí-Fàbregas, Nicola Giannotti, Alejandro Fernández-León, View ORCID ProfileJonathan P. McNulty, Jean-Claude Baron, Mary Barry, View ORCID ProfileShelagh B. Coutts, Simon Cronin, View ORCID ProfileRaquel Delgado-Mederos, Eamon Dolan, View ORCID ProfileShane Foley, View ORCID ProfileMarina Guasch-Jiménez, View ORCID ProfileDaniel Guisado-Alonso, Joseph A. Harbison, Gillian Horgan, View ORCID ProfileEoin C. Kavanagh, Michael Marnane, Alejandro Martínez-Domeño, Ciaran McDonnell, Vijay K. Sharma, View ORCID ProfileDavid Williams, Martin O. Connell, Sean Murphy, View ORCID ProfileLuis Prats-Sánchez, Peter J. Kelly
First published April 13, 2022, DOI: https://doi.org/10.1212/WNL.0000000000200525
Pol Camps-Renom
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
John McCabe
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Joan Martí-Fàbregas
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Nicola Giannotti
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Alejandro Fernández-León
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Jonathan P. McNulty
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Jean-Claude Baron
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Mary Barry
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Shelagh B. Coutts
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Simon Cronin
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Raquel Delgado-Mederos
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Eamon Dolan
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Shane Foley
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Marina Guasch-Jiménez
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Daniel Guisado-Alonso
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Joseph A. Harbison
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Gillian Horgan
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Eoin C. Kavanagh
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Michael Marnane
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Alejandro Martínez-Domeño
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Ciaran McDonnell
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Vijay K. Sharma
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
David Williams
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Martin O. Connell
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Sean Murphy
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Luis Prats-Sánchez
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Peter J. Kelly
From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.
Association of Plaque Inflammation With Stroke Recurrence in Patients With Unproven Benefit From Carotid Revascularization
Pol Camps-Renom, John McCabe, Joan Martí-Fàbregas, Nicola Giannotti, Alejandro Fernández-León, Jonathan P. McNulty, Jean-Claude Baron, Mary Barry, Shelagh B. Coutts, Simon Cronin, Raquel Delgado-Mederos, Eamon Dolan, Shane Foley, Marina Guasch-Jiménez, Daniel Guisado-Alonso, Joseph A. Harbison, Gillian Horgan, Eoin C. Kavanagh, Michael Marnane, Alejandro Martínez-Domeño, Ciaran McDonnell, Vijay K. Sharma, David Williams, Martin O. Connell, Sean Murphy, Luis Prats-Sánchez, Peter J. Kelly
Neurology Jul 2022, 99 (2) e109-e118; DOI: 10.1212/WNL.0000000000200525
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Abstract
Background and Objectives In pooled analyses of endarterectomy trials for symptomatic carotid stenosis, several subgroups experienced no net benefit from revascularization. The validated symptomatic carotid atheroma inflammation lumen-stenosis (SCAIL) score includes stenosis severity and inflammation measured by PET and improves the identification of patients with recurrent stroke compared with lumen-stenosis alone. We investigated whether the SCAIL score improves the identification of recurrent stroke in subgroups with uncertain benefit from revascularization in endarterectomy trials.
Methods We did an individual-participant data pooled analysis of 3 prospective cohort studies (Dublin Carotid Atherosclerosis Study [DUCASS], 2008–2011; Biomarkers and Imaging of Vulnerable Atherosclerosis in Symptomatic Carotid Artery Disease [BIOVASC], 2014–2018; Barcelona Plaque Study, 2015–2018). Eligible patients had a recent nonsevere (modified Rankin Scale score ≤3) anterior circulation ischemic stroke/TIA and ipsilateral mild carotid stenosis (<50%); ipsilateral moderate carotid stenosis (50%–69%) plus at least 1 of female sex, age <65 years, diabetes mellitus, TIA, or delay >14 days to revascularization; or monocular loss of vision. Patients underwent coregistered carotid 18F-fluorodeoxyglucosePET/CT angiography (≤7 days from inclusion). The primary outcome was 90-day ipsilateral ischemic stroke. Multivariable Cox regression modeling was performed.
Results We included 135 patients. All patients started optimal modern-era medical treatment at admission, and 62 (45.9%) underwent carotid revascularization (36 within the first 14 days and 26 beyond). At 90 days, 18 (13.3%) patients had experienced at least 1 stroke recurrence. The risk of recurrence increased progressively according to the SCAIL score (0.0% in patients scoring 0–1, 15.1% scoring 2–3, and 26.7% scoring 4–5; p = 0.04). The adjusted (age, smoking, hypertension, diabetes, carotid revascularization, antiplatelets and statins) hazard ratio for ipsilateral recurrent stroke per 1-point SCAIL increase was 2.16 (95% CI 1.32–3.53; p = 0.002). A score ≥2 had a sensitivity of 100% for recurrence.
Discussion The SCAIL score improved the identification of early recurrent stroke in subgroups who did not experience benefit in endarterectomy trials. Randomized trials are needed to test whether a combined stenosis-inflammation strategy will improve selection for carotid revascularization when benefit is currently uncertain.
Classification of Evidence This study provides Class II evidence that, in patients with recent anterior circulation ischemic stroke who do not benefit from carotid revascularization, the SCAIL score accurately distinguishes those at risk for recurrent ipsilateral ischemic stroke.
Glossary
- ARR=
- absolute risk reduction;
- BIOVASC=
- Biomarkers and Imaging of Vulnerable Atherosclerosis in Symptomatic Carotid Artery Disease;
- CEA=
- carotid endarterectomy;
- CTA=
- CT angiography;
- DUCASS=
- Dublin Carotid Atherosclerosis Study;
- ECST=
- European Carotid Surgery Trial;
- 18F-FDG=
- 18F-fluorodeoxyglucose;
- IQR=
- interquartile range;
- MRA=
- magnetic resonance angiography;
- NASCET=
- North American Symptomatic Carotid Surgery Trial;
- SCAIL=
- symptomatic carotid atheroma inflammation lumen-stenosis;
- SHS=
- single hottest slice;
- SUV=
- standardized uptake value
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Brad Worrall, MD, MSc, FAAN.
Class of Evidence: NPub.org/coe
- Received August 24, 2021.
- Accepted in final form March 1, 2022.
- © 2022 American Academy of Neurology
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