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Title: The identification of the vulnerable carotid plaque and haemodynamic compromise of the brain in carotid artery stenosis
Author: Cheng, Suk Fun
ISNI:       0000 0004 8499 892X
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2019
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Introduction: Carotid stenosis plays a large role in the aetiology of ischaemic stroke. The main mechanism of carotid stenosis causing stroke is the forming of thrombus and consequently embolus formation. Another mechanism is the compromise in haemodynamics: reduced blood flow distal from the stenosis causing hypoperfusion of the brain. This work investigates the current prevalence of carotid stenosis in ischaemic stroke. It also explores the role of transcranial Doppler (TCD) and brain perfusion imaging with magnetic resonance imaging in patients with carotid stenosis. Methods: The current prevalence of carotid stenosis was assessed in a comprehensive Central London hyper-acute stroke unit and a systematic review with meta-regression analysis was conducted on the prevalence of carotid stenosis. Patient individual risk factors and morphological characteristics of the carotid plaque were associated with the presence of micro-embolic signals on TCD. The perfusion of the brain was assessed in patients with carotid stenosis and those who underwent carotid endarterectomy (CEA). Results: The prevalence of carotid stenosis 350% in the local stroke unit was 19.0%, including 7.9% with symptomatic stenosis. The pooled prevalence estimate of carotid stenosis, described in 37 studies in the literature, was 16.0% and has not declined over time. Intraplaque haemorrhage was associated with a higher risk of future stroke by detection of micro-embolic signals on TCD. Haemodynamic factors played a great role in stroke, especially in patients with stenosis 370%. Cerebral perfusion improved significantly in patients who underwent CEA, especially in those who initially had 370% stenosis. Conclusion: Morphology of the plaque, more than the degree of stenosis, is an important predictive feature of the unstable carotid plaque, whilst the degree of stenosis is more relevant to the hypoperfused brain. There is evidence for a synergic role of embolism and haemodynamic compromise as a mechanism of ischaemic stroke in carotid stenosis.
Supervisor: Richards, T. ; Brown, M. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available