473-119 | Effect of Internal Carotid Artery Doppler Peak-Systolic Velocity Thresholds for Classifying Ipsilateral Ischemic Stroke Due to Large Artery Atherosclerosis According to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) System-JVU 473-119

JVU 473-119

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This research article explores the effect of changing the peak systolic velocity (PSV) threshold for classifying ischemic stroke due to large artery atherosclerosis (LAA) according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) system. The study used color Doppler-assisted measurements of PSV in a large longitudinal cohort study called the Cardiovascular Health Study (CHS). The incidence rates and odds ratios of ipsilateral ischemic stroke were estimated at PSV thresholds of 125 cm/s and 180 cm/s.<br /><br />The results showed that an increase in PSV is associated with an increasing risk of ischemic stroke. Shifting the PSV threshold from 125 cm/s to 180 cm/s significantly decreased the proportion of strokes classified as LAA. Specifically, 70% of strokes classified as LAA using the 125 cm/s threshold would have been missed if the 180 cm/s threshold had been used.<br /><br />The study suggests that changing the PSV threshold could underestimate the risk of stroke associated with LAA. The adoption of a higher threshold could exclude patients with clinically significant stenosis from further evaluation. The findings highlight the need to consider other factors, such as plaque morphology, in stroke classification.<br /><br />The limitations of the study include data acquired from multiple clinic sites and a population that may not be representative. The low number of stroke cases also resulted in wide confidence intervals for higher PSV values.<br /><br />The study concludes that changing the PSV threshold for defining significant carotid stenosis would have significant implications for classifying ischemic stroke as being associated with LAA. Further research is needed to clarify this issue and determine the optimal PSV threshold for stroke classification.

Keywords

peak systolic velocity

PSV threshold

ischemic stroke

large artery atherosclerosis

Trial of Org 10172 in Acute Stroke Treatment

TOAST system

color Doppler-assisted measurements

Cardiovascular Health Study

incidence rates

odds ratios