Extracranial and Intracranial Non-Stenotic Carotid Atherosclerotic Plaques in ESUS Patients (P5.221)

Objective: Our aim was to assess the prevalence of non-stenotic extracranial and intracranial carotid atherosclerotic plaques (CAP) in our embolic stroke of undetermined source (ESUS) patients, hence to help better define this population. Background: Mild and nonstenosing CAP represents a possible but underestimated thromboembolic source in ESUS patients. Design/Methods: In this cross-sectional retrospective study, we included ESUS patients admitted to our stroke unit consecutively between Oct 2011 and Aug 2015. Patients with posterior circulation stroke and poor quality/no CTA were excluded. We compared the prevalence of CAP, defined by the presence of calcified and/or non-calcified plaque on 3 views (axial, coronal, and sagittal) on CTA in ESUS patients. Baseline characteristics of ESUS patients with CAP were compared to those without CAP. Results: Off all ESUS patients [N=158, median age 73.5 (range 24–93), 56.3% female)], 89 (56.3%) patients met the inclusion criteria. CAP was present in 34.8% of ESUS patients. ESUS patients with CAP were older than those without CAP (mean age 75 vs. 56.9, P Conclusions: Our study found a high prevalence of CAP in ESUS patients, with also higher prevalence of traditional risk factors associated with systemic atherosclerosis in this group. Detection of CAP on CTA may help therapeutic stratification and improve secondary prevention strategies in this stroke population. Given that initial clinical trials using novel anticoagulants in secondary stroke prevention in ESUS population did not show benefit over aspirin (NAVIGATE Study), it is now critical to better define ESUS population for future prospective studies. Disclosure: Dr. Rajalingam has nothing to disclose. Dr. Jalini has nothing to disclose. Dr. Pikula has nothing to disclose.