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ABCD² risk score does not predict the presence of cerebral microemboli in patients with hyper-acute symptomatic critical carotid artery stenosis
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Saedon, Mahmud H., Hutchinson, Charles E., Imray, C. (Chris) and Singer, Donald R. J. (2017) ABCD² risk score does not predict the presence of cerebral microemboli in patients with hyper-acute symptomatic critical carotid artery stenosis. Stroke and Vascular Neurology, 2 (2). pp. 41-46. doi:10.1136/svn-2017-000073 ISSN 2059-8688.
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Official URL: https://doi.org/10.1136/svn-2017-000073
Abstract
ABCD² 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.
We 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.
140/206 (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 <4 in 27 of 86 (31%: 95% CI 21 to 41) embolising patients and in 39 of 120 (31%: 95% CI 23 to 39) without cerebral microemboli. After adjusting for pre-neurological event antiplatelet treatment (APT), area under the curve (AUC) of ROC for ABCD2 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)).
The 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.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RC Internal medicine | ||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| SWORD Depositor: | Library Publications Router | ||||||||
| Library of Congress Subject Headings (LCSH): | Transient ischemic attack, Carotid artery -- Stenosis, Transcranial Doppler ultrasonography, Embolism | ||||||||
| Journal or Publication Title: | Stroke and Vascular Neurology | ||||||||
| Publisher: | BMJ Publishing Group Ltd. | ||||||||
| ISSN: | 2059-8688 | ||||||||
| Official Date: | 1 June 2017 | ||||||||
| Dates: |
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| Volume: | 2 | ||||||||
| Number: | 2 | ||||||||
| Page Range: | pp. 41-46 | ||||||||
| DOI: | 10.1136/svn-2017-000073 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Reuse Statement (publisher, data, author rights): | ** From Europe PMC via Jisc Publications Router. ** Licence for this article: cc by-nc | ||||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||||
| Date of first compliant deposit: | 13 December 2017 | ||||||||
| Date of first compliant Open Access: | 13 December 2017 | ||||||||
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