Open Access Study protocol

The carotid plaque imaging in acute stroke (CAPIAS) study: protocol and initial baseline data

Anna Bayer-Karpinska1, Florian Schwarz2, Frank A Wollenweber1, Holger Poppert7, Tobias Boeckh-Behrens8, Alexander Becker56, Dirk A Clevert25, Konstantin Nikolaou25, Christian Opherk145, Martin Dichgans15* and Tobias Saam35*

Author Affiliations

1 Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Marchioninistr 15, 81377 Munich, Germany

2 Institute for Clinical Radiology, Klinikum der Universität München, Ludwig-Maximilians-University, Marchioninistr 15, 81377 Munich, Germany

3 Institute for Clinical Radiology, Klinikum der Universität 555 München, Ludwig-Maximilians-University, Pettenkoferstr 8a, 80336, 556 Munich, Germany

4 Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-University, Marchioninistr 15, 81377 Munich, Germany

5 Interdisciplinary Stroke Center, Klinikum der Universität 559 München, Ludwig-Maximilians-University, Marchioninistr 15, 81377, 560 Munich, Germany

6 Department of Cardiology, Klinikum der Universität München, Ludwig-Maximilians-University, Marchioninistr 15, 81377 Munich, Germany

7 Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany

8 Department of Neuroradiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany

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BMC Neurology 2013, 13:201  doi:10.1186/1471-2377-13-201

Published: 13 December 2013

Abstract

Background

In up to 30% of patients with ischemic stroke no definite etiology can be established. A significant proportion of cryptogenic stroke cases may be due to non-stenosing atherosclerotic plaques or low grade carotid artery stenosis not fulfilling common criteria for atherothrombotic stroke. The aim of the CAPIAS study is to determine the frequency, characteristics, clinical and radiological long-term consequences of ipsilateral complicated American Heart Association lesion type VI (AHA-LT VI) carotid artery plaques in patients with cryptogenic stroke.

Methods/Design

300 patients (age >49 years) with unilateral DWI-positive lesions in the anterior circulation and non- or moderately stenosing (<70% NASCET) internal carotid artery plaques will be enrolled in the prospective multicenter study CAPIAS. Carotid plaque characteristics will be determined by high-resolution black-blood carotid MRI at baseline and 12 month follow up. Primary outcome is the prevalence of complicated AHA-LT VI plaques in cryptogenic stroke patients ipsilateral to the ischemic stroke compared to the contralateral side and to patients with defined stroke etiology. Secondary outcomes include the association of AHA-LT VI plaques with the recurrence rates of ischemic events up to 36 months, rates of new ischemic lesions on cerebral MRI (including clinically silent lesions) after 12 months and the influence of specific AHA-LT VI plaque features on the progression of atherosclerotic disease burden, on specific infarct patterns, biomarkers and aortic arch plaques.

Discussion

CAPIAS will provide important insights into the role of non-stenosing carotid artery plaques in cryptogenic stroke. The results might have implications for our understanding of stroke mechanism, offer new diagnostic options and provide the basis for the planning of targeted interventional studies.

Trial Registration

NCT01284933

Keywords:
Atherosclerosis; Cryptogenic stroke; Internal carotid artery; Plaque imaging; MRI