title: A prediction model for unstable carotid atheromatous plaque in acute ischemic stroke patients: proposal and internal validation.
abstract: The aim of this prospective study was to analyze the utility of a gray-scale median (GSM) system for identifying unstable plaques and to design and validate a prediction model for unstable plaques in symptomatic atheromatous carotid arteries. Fifty-two patients with non-cardioembolic cerebral infarction were included in the study. The receiver operating characteristic analysis revealed 76% sensitivity and 82% specificity for a GSM of 29 (p < 0.001) as a cutoff point for unstable plaques. A logistic regression model indicated that a GSM <29, male gender and not having been treated with angiotensin-converting enzyme inhibitors were independently associated with an unstable plaque classification. A probability model for unstable plaques was achieved by combining the strength of each variable (high blood pressure, hypercholesterolemia, smoking, previous stroke, anti-hypertensive drugs, calcium channel blockers, intima-media thickness). The model was tested with receiver operating characteristic curve analysis (p < 0.001) and validated by the leave-one-out cross-validation method (p < 0.001). The prediction model based on a GSM <29, male gender and not having been treated with angiotensin-converting enzyme inhibitors resulted in a probable unstable plaque assessment.
authors.affiliation: Department of Neurology, Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Ruiz-Ares
authors.affiliation: Department of Neurology, Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Fuentes
authors.affiliation: Department of Neurology, Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Martínez-Sánchez
authors.affiliation: Department of Neurology, Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Universidad Autónoma de Madrid, Madrid, Spain. Electronic address: exuperio.diez@salud.madrid.org.
authors.forename: Exuperio
authors.initials: E
authors.lastname: Díez-Tejedor
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008962:Models, Theoretical; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging*; D014463:Ultrasonography
keywords: Atherosclerosis; Carotid atheromatous plaques; Gray scale; Ischemic stroke; Stroke; Ultrasound