Importance After a transient ischemic attack (TIA) or minor stroke, the long-term risk of stroke is not well-known. Objective To determine the annual incidence rates and cumulative incidences of stroke up to 10 years after TIA or minor stroke. Data Sources MEDLINE, Embase, and Web of Science were searched from inception through June 26, 2024. Study Selection Prospective or retrospective cohort studies reporting stroke risk during a minimum follow-up of 1 year in patients with TIA or minor stroke. Data Extraction and Synthesis Two reviewers independently performed data extraction and assessed study quality. Unpublished aggregate-level data on number of events and person-years during discrete follow-up intervals were obtained directly from the authors of the included studies to calculate incidence rates in individual studies. Data across studies were pooled using random-effects meta-analysis. Main Outcomes and Measures The primary outcome was any stroke. Study-level characteristics were investigated as potential sources of variability in stroke rates across studies. Results The analysis involved 171 068 patients (median age, 69 years [IQR, 65-71]; median proportion of male patients, 57% [IQR, 52%-60%]) from 38 included studies. The pooled rate of stroke per 100 person-years was 5.94 events (95% CI, 5.18-6.76; 38 studies; I-2 = 97%) in the first year, 1.80 events (95% CI, 1.58-2.04; 25 studies; I-2 = 90%) annually in the second through fifth years, and 1.72 events (95% CI, 1.31-2.18; 12 studies; I-2 = 84%) annually in the sixth through tenth years. The 5- and 10-year cumulative incidence of stroke was 12.5% (95% CI, 11.0%-14.1%) and 19.8% (95% CI, 16.7%-23.1%), respectively. Stroke rates were higher in studies conducted in North America (rate ratio [RR], 1.43 [95% CI, 1.36-1.50]) and Asia (RR, 1.62 [95% CI, 1.52-1.73]), compared with Europe, in cohorts recruited in or after 2007 (RR, 1.42 [95% CI, 1.23-1.64]), and in studies that used active vs passive outcome ascertainment methods (RR, 1.11 [95% CI, 1.07-1.17]). Studies focusing solely on patients with TIA (RR, 0.68 [95% CI, 0.65-0.71) or first-ever index events (RR, 0.45 [95% CI, 0.42-0.49]) had lower stroke rates than studies with an unselected patient population. Conclusions and Relevance Patients who have had a TIA or minor stroke are at a persistently high risk of subsequent stroke. Findings from this study underscore the need for improving long-term stroke prevention measures in this patient group.

The efficacy of ticagrelor 90mg and aspirin (ticagrelor-aspirin) for the prevention of stroke following an ischaemic stroke (IS) or transient ischaemic attack (TIA) was evaluated in the Acute STroke or Transient IscHaemic Attack Treated With TicAgreLor and ASA for PrEvention of Stroke and Death (THALES, NCT03354429) trial. Ticagrelor-aspirin resulted in a 17% reduction in the risk of stroke or death over 30 days versus aspirin, but with more bleeding events. Ticagrelor 90mg is approved to reduce stroke risk in patients with acute IS (NIH Stroke Scale score ≤5) or high-risk TIA by the Food and Drug Administration.

Background. - and purpose. - As a result of contraindications (e.g., frailty, cognitive impairment, co-morbidities) or patient refusal, 40% of patients with stroke and atrial fibrillation cannot be discharged on oral anticoagulant (OAC). Among them, the proportion of potential candidates for left atrial appendage closure (LAAC) and their risk of stroke recurrence or 12-month outcome is not well known.Methods. - The prospective WATCH-AF registry consecutively enrolled patients admitted within 72 hours of an acute stroke associated with atrial fibrillation in two stroke centers. Scales to evaluate stroke severity, disability, functional independence, risk of fall, cognition, ischemic and hemorrhagic risk-stratification and co-morbidities were systematically collected at admission, discharge, 3 and 12 months post stroke. The two main endpoints were death or dependency(mRS > 3) and recurrent stroke (brain infarction or brain hemorrhage).Results. - Among 400 enrolled patients (370 with brain infarction, 30 with brain hemorrhage) 31 died before discharge and 57 (14.3%) were possible ERHA/ESC and AHA/ACC/HRS candidates for LAAC. At 12 months, the rate of death or dependency was 17.9 % and the rate of stroke recurrence was 9.8% in the 274/400 (68.5%) patients discharged on a long-term OAC strategy, as compared to 17.5% and 24.7%, respectively (10 and 14 patients) in 57 patients candidate for LAAC. As compared to patients on a long-term anticoagulation, there was a 2-and-a-half fold increase in the risk of stroke recurrence at one year in the group with an indication for LAAC(adjusted HR 2.58 [95% CI, 1.40-4.76; P = 0.002]).Conclusions. - In all, 14% of patients with stroke associated with atrial fibrillation were the potential candidates for LAAC. The 12-month stroke risk of these patients was 2 and a half times that of anticoagulated patients. (C) 2021 Published by Elsevier Masson SAS on behalf of l'Academie nationale de medecine.

Du fait de contre-indications (personne âgée fragile, troubles cognitifs, co-morbidités) ou du refus par le patient, 40 % des patients après un AVC lié à une fibrillation atriale ne sont pas traités par anticoagulant. Parmi ceux-là, nous ne connaissons pas la proportion de ceux qui seraient des candidats potentiels à la fermeture de l’auricule gauche ni leur risque de récidive d’AVC ou de handicap à 1 an. Le registre prospectif WATCH-AF a inclus consécutivement des patients dans les 72 heures suivant leur admission pour un AVC associé à une fibrillation atriale dans deux unités d’AVC. À l’admission, à la sortie de l’hôpital, à 3 mois et à 12 mois post AVC, nous avons collecté les résultats des échelles d’évaluation de la sévérité de l’AVC, du handicap, de l’indépendance fonctionnelle, du risque de chute, de la cognition, et de la stratification du risque ischémique ou hémorragique. Les critères de jugement ont été la mort ou la dépendance (mRS > 3) et la récidive d’AVC (infarctus ou hémorragie cérébrale). Sur 400 patients inclus (370 avec un infarctus cérébral, et 30 avec une hémorragie cérébrale) 31 sont morts au cours de l’hospitalisation et 57 (14,3 %) avaient une indication potentielle de fermeture de l’auricule gauche selon les recommandations de l’ERHA/ESC et de l’AHA/ACC/HRS. Après 12 mois, parmi les 274/400 (68,5 %) patients sortis de l’hôpital sous anticoagulation à long-terme, 49 (17,9 %) patients étaient morts ou dépendants et le risque de récidive d’AVC était de 9,8 % (26 patients). Chez les 57 patients sortis sans anticoagulation et qui étaient candidats à la fermeture de l’auricule gauche, ces risques étaient de 17,5 % et 24,7 % (10 et 14 patients), respectivement. Comparativement aux patients traités à long-terme par anticoagulant, les candidats à la fermeture de l’auricule gauche avaient deux fois et demi plus de risque de récidive d’AVC à 1 an (HR ajusté 2,58 [IC à 95 %, 1,40–4,76 ; p = 0,002]). Au total, 14 % des patients qui ont un AVC associé à une fibrillation atriale sont des candidats potentiels à la fermeture de l’auricule gauche et leur risque de récidive à 1 an étaient 2 fois et demie celui des patients anticoagulés. As a result of contraindications (e.g., frailty, cognitive impairment, co-morbidities) or patient refusal, 40% of patients with stroke and atrial fibrillation cannot be discharged on oral anticoagulant (OAC). Among them, the proportion of potential candidates for left atrial appendage closure (LAAC) and their risk of stroke recurrence or 12-month outcome is not well known. The prospective WATCH-AF registry consecutively enrolled patients admitted within 72 hours of an acute stroke associated with atrial fibrillation in two stroke centers. Scales to evaluate stroke severity, disability, functional independence, risk of fall, cognition, ischemic and hemorrhagic risk-stratification and co-morbidities were systematically collected at admission, discharge, 3 and 12 months post stroke. The two main endpoints were death or dependency (mRS > 3) and recurrent stroke (brain infarction or brain hemorrhage). Among 400 enrolled patients (370 with brain infarction, 30 with brain hemorrhage) 31 died before discharge and 57 (14.3%) were possible ERHA/ESC and AHA/ACC/HRS candidates for LAAC. At 12 months, the rate of death or dependency was 17.9 % and the rate of stroke recurrence was 9.8% in the 274/400 (68.5%) patients discharged on a long-term OAC strategy, as compared to 17.5% and 24.7%, respectively (10 and 14 patients) in 57 patients candidate for LAAC. As compared to patients on a long-term anticoagulation, there was a 2-and-a-half fold increase in the risk of stroke recurrence at one year in the group with an indication for LAAC (adjusted HR 2.58 [95% CI, 1.40–4.76; P = 0.002]). In all, 14% of patients with stroke associated with atrial fibrillation were the potential candidates for LAAC. The 12-month stroke risk of these patients was 2 and a half times that of anticoagulated patients.

Background. Intensive lipid lowering therapy using statin is recommended after transient ischemic attack (TIA) or ischemic stroke of atherosclerotic origin. There is some uncertainty, however about the target level of LDL cholesterol that is appropriate to reduce cardiovascular events after stroke. Methods. Patients with ischemic stroke in the previous 3 months or TIA within the previous 15 days and evidence of cerebrovascular or coronary artery atherosclerosis were randomly assigned in a 1:1 ratio to a target LDL cholesterol of less than 70 mg/dL or 100 10 mg/dL, using statin alone or in combination with ezetimibe. The primary criterion was the composite of ischemic stroke, myocardial infarction, new symptoms requiring urgent coronary or carotid revascularization and vascular death. Results. A total of 2860 patients were enrolled, 1430 assigned to each group, with a mean baseline LDL cholesterol of 135 mg/dL and followed for a median of 3.5 years. The mean achieved LDL cholesterol levels were 65 and 96 mg/dL, respectively. The primary composite endpoint occurred in 121 (8.5%) and in 156 (10.9%) patients, respectively (adjusted hazard ratio, 0.78; 95% confidence interval, 0.61-0.98; P=0.036). The incidence of intracranial hemorrhages and newly diagnosed diabetes did not differ between groups. Conclusions. After an ischemic stroke with evidence of atherosclerosis, a target LDL cholesterol of less than 70 mg/dL compared to 100 10 mg/dL, reduced the risk of subsequent cardiovascular events. (C) 2020 l'Academie nationale de medecine. Published by Elsevier Masson SAS. All rights reserved.

BACKGROUNDThe use of intensive lipid-lowering therapy by means of statin medications is recommended after transient ischemic attack (TIA) and ischemic stroke of atherosclerotic origin. The target level for low-density lipoprotein (LDL) cholesterol to reduce cardiovascular events after stroke has not been well studied.METHODSIn this parallel-group trial conducted in France and South Korea, we randomly assigned patients with ischemic stroke in the previous 3 months or a TIA within the previous 15 days to a target LDL cholesterol level of less than 70 mg per deciliter (1.8 mmol per liter) (lower-target group) or to a target range of 90 mg to 110 mg per deciliter (2.3 to 2.8 mmol per liter) (higher-target group). All the patients had evidence of cerebrovascular or coronary-artery atherosclerosis and received a statin, ezetimibe, or both. The composite primary end point of major cardiovascular events included ischemic stroke, myocardial infarction, new symptoms leading to urgent coronary or carotid revascularization, or death from cardiovascular causes.RESULTSA total of 2860 patients were enrolled and followed for a median of 3.5 years; 1430 were assigned to each LDL cholesterol target group. The mean LDL cholesterol level at baseline was 135 mg per deciliter (3.5 mmol per liter), and the mean achieved LDL cholesterol level was 65 mg per deciliter (1.7 mmol per liter) in the lower-target group and 96 mg per deciliter (2.5 mmol per liter) in the higher-target group. The trial was stopped for administrative reasons after 277 of an anticipated 385 end-point events had occurred. The composite primary end point occurred in 121 patients (8.5%) in the lower-target group and in 156 (10.9%) in the higher-target group (adjusted hazard ratio, 0.78; 95% confidence interval, 0.61 to 0.98; P = 0.04). The incidence of intracranial hemorrhage and newly diagnosed diabetes did not differ significantly between the two groups.CONCLUSIONSAfter an ischemic stroke or TIA with evidence of atherosclerosis, patients who had a target LDL cholesterol level of less than 70 mg per deciliter had a lower risk of subsequent cardiovascular events than those who had a target range of 90 mg to 110 mg per deciliter. (Funded by the French Ministry of Health and others; Treat Stroke to Target ClinicalTrials.gov number, NCT01252875.).

Aims The aim of this study was to estimate patient and caregiver productivity loss and indirect costs following an acute coronary syndrome (ACS) or a stroke in Europe. Methods A cross-sectional study was conducted in seven European countries. A validated questionnaire was used during a cardiologist/neurologist visit 3-12 months post event. We included patients who returned to work ( >= 4 weeks prior to recruitment), given specific interest in presenteeism. Patient absenteeism, presenteeism and caregiver loss in the past four weeks were pro-rated to one year and combined with time-off due to initial hospitalisation/sick-leave. Hours lost were valued according to country labour cost (2018 euros). Results The analysis included 196 ACS (86% myocardial infarction) and 198 stroke (99% ischaemic, 77% modified Rankin Scale 0-1) patients. Mean age in ACS and stroke patients was 53 years, 86% and 78% respectively were men, 28% and 25% had previous cardiovascular event or established cardiovascular disease. Mean (country range) total productivity time loss was 70 (47-91) workdays for ACS and 68 (45-88) workdays for stroke (25% of annual workdays). Particularly, ACS patient lost 59 (37-79) workdays, and caregivers lost 11 (0-16) workdays, with total mean indirect cost per case euro13,953 (euro6641-23,160). After stroke, 56 (42-70) workdays were lost by patient plus 12 (3-20) days by caregiver, amounting to euro13,773 (euro10,469-20,215). Patients with previous events or established cardiovascular disease lost 80 (ACS) and 73 (stroke) workdays, costing euro16,061 and euro14,942 respectively. Conclusions Our results suggest that lost productive time and indirect costs following ACS/stroke are substantial, with indirect costs comparable to direct costs.

Chez les patients bénéficiant de TEP 18F-FDG pour bilan oncologique, une importante fixation pariétale aortique ascendante est associée à un risque élevé d’évènements cardiovasculaires. Ces constatations sont, par contre, peu étayées sur des patients suivis pour une athérosclérose authentique. L’objectif de cette étude était d’évaluer la valeur pronostique du TBR aortique obtenu par TEP 18F-FDG de patients suivis pour une maladie vasculaire coronaire ou carotidienne, concernant la survenue d’évènements athéro-thrombotiques. Cent quatre-vingt-dix patients avec un syndrome coronarien aigu non ST+ (n = 36), une coronaropathie stable (n = 26) ou une sténose carotidienne symptomatique (n = 128) et évalués par TEP 18F-FDG ont été sélectionnés au sein de différentes études cliniques réalisées dans notre département d’imagerie. Tous les patients ont bénéficié du même protocole TEP-TDM 90 min après injection de 4 MBq/kg de 18F-FDG. Le SUVmax pariétal ainsi que le SUVmoyen du bruit de fond sanguin ont été mesurés grâce à des régions d’intérêt axiales (ROI) étagées, 8 pour l’aorte ascendante et 10 pour la veine cave supérieure. Le TBR aortique était calculé grâce au ratio entre la moyenne des 8 ROI aortiques et la moyenne des 10 ROI de la veine cave. Seuls les patients avec un suivi d’au moins 1 mois ont été inclus. Les évènements athéro-thrombotiques étaient définis comme un décès d’origine cardiaque, l’apparition d’un nouvel épisode ischémique ou nécrotique myocardique, cérébral ou périphérique. L’âge moyen de la population était de 67 ± 4,4 ans, avec 70 % d’hommes. La majorité des patients était traitée par anti-thrombotiques (88 %) et statines (90 %). Après un suivi moyen de 3,5 ans, un ou plusieurs évènements athéro-thrombotiques est survenu chez 27 % des patients. Le taux d’évènements était plus important quand le TBR était élevé : tercile 1 (TBR : 1,22–1,57) : 20,6 % ; tercile 2 (TBR : 1,58–1,74) : 27 % ; tercile 3 (TBR : 1,75–2,31) : 32,8 %. Le TBR aortique était également plus élevé dans le groupe de patients développant des évènements cardiovasculaires versus ceux asymptomatiques (1,77 ± 0,20 vs 1,65 ± 0,21 ; p = 0,005). Par contre, aucune différence n’était retrouvée chez les patients développant des évènements cérébraux versus ceux asymptomatiques (1,67 ± 0,18 vs 1,66 ± 0,21 ; p = 0,86). En cas de pathologie athéromateuse coronarienne ou carotidienne, une importante fixation pariétale aortique est associée avec un risqué élevé d’évènements cardiovasculaires.

Transient ischemic cerebral (or retinal) attack (TIA) or minor ischemic stroke (with no handicap left) is the best opportunity to prevent a handicap due to a new brain infarction, provided the patient is evaluated as soon as possible to find out the cause and treated immediately. This risk is very high within the first 90 days, particularly the first 10-20 days, then tends to decrease, suggesting a low long-term risk. This long-term risk is however not well known. The TIAregistry.org aimed to determine the short- and long-term risks in patients with TIA or minor ischemic stroke. Patients were consecutively included in 61 neurovascular units organized for emergent TIA management in 21 countries in Europe, Middle-East, Asia and Latin America, as early as possible and no later than 7 days after the qualifying event. They were followed up over the next 5 years. The primary end-point was stroke, myocardial infarction or vascular death. Of 4739 patients, 80% were included within 24 hours of symptom onset, of whom 3847 were followed 5 years. Despite optimal therapeutic management over the 5 years, the risk of primary endpoint was 4%, 6.2% [95% CI, 5.5-7.0%], and 12.9% [95% CI, 11.8-14.1%], at 3 months, 1 and 5 years, respectively. Half of the risk was observed over the first 365 days following the TIA or minor ischemic stroke, and half of events occurred between 1 and 5 years. At 5 years, the risk of all cause death, cardiovascular death, major hemorrhage, and intracranial hemorrhage was 10.6%, 2.7%, 1.5%, and 1.1%, respectively. The 5-year stroke risk was 9.5%. The risk of handicap (modified Rankin scale > 1) due to a stroke at 5 years was 7.9% [95% CI, 7.1-8.9%]. In conclusion, after a TIA of a minor ischemic stroke the risk of major vascular event was 6.5% at one year and 13% at 5 years. The risk is the highest during the first days, then steadily increases until 5 years, and 60% of the events were stroke with significant handicap. New prevention strategies are needed to address this risk. (C) 2019 Published by Elsevier Masson SAS on behalf of l'Academie nationale de medecine.

The aim of the current research is to extrapolate the results of a cross-sectional study of patient and caregiver productivity loss in the first year after an acute coronary syndrome (ACS) or stroke conducted in seven European countries to 13 other European countries in which patient-level data collection was not feasible (Austria, Bulgaria, Croatia, Czech Republic, Denmark, Finland, Germany, Greece, Italy, Norway, Romania, Slovakia, Slovenia). The original study used a validated questionnaire to collect total time loss including patient initial hospitalisation and sick-leave, patient absenteeism after return to work, patient presenteeism and caregiver time. Patients included represented only those who could return to work, because of a specific interest in presenteeism. Mean total lost time from the original study was extrapolated and valued using national labor costs (€2017, updated to 2018). To ensure a conservative basis for extrapolation, we statistically identified and excluded extreme outliers from the original dataset (ACS N=8/196; Stroke N=5/198). The 13 countries were grouped according to their GDP and geography into Northern/Western and Southern/Eastern Europe. The original study estimated a mean (±SD) loss of 70.2±83.8 and 67.6±82.4 workdays for ACS and stroke patients respectively. After excluding extreme outliers, the annual time lost was 56.7±12.3 workdays per ACS patient/caregiver and 59.3±14.0 workdays per Stroke patient/caregiver. In Northern/Western Europe, this time loss resulted in mean (country range) indirect costs of €17,241 (€13,051-23,053) for ACS and €17,735 (€13,425-23,714) for Stroke. In Southern/Eastern Europe, estimated indirect costs amounted to €5,121 (€2,430-7,978) for ACS and €5,268 (€2,500-8,207) for Stroke. These estimates depend on countries’ healthcare/social welfare systems. Total productivity loss for a patient and caregiver in the first year after ACS/Stroke in Europe is substantial, amounting up to 60 workdays (25% of annual workdays). Further research in productivity loss and indirect costs should be conducted.

Introduction.In patients imaged for oncological indications, high vascular FDG uptake in the ascending aortic on FDG-PET was associated with an increased rate of cardiovascular events during follow-up.Whether the results observed in patients imaged with FDG-PET for oncological indications hold true in patients with overt atherothrombotic disease remains elusive.Purpose.The aim of this study was to evaluate the value of aortic TBR measured on FDG-PET in patients with overt coronary and carotid artery disease to predict atherothrombotic events.Methods.A total of 190 patients with NSTEMI (n = 36), stable CAD (n = 26) or symptomatic carotid stenosis (n = 128) evaluated with FDG-PET were identified among different clinical studies which took place in our institution.All patients were imaged with the same PET-CT system 90 minutes after the injection of 4 MBq/ kg of FDG.Max SUV of the vascular wall and mean SUV of blood were measured on PET axial slices in 8 regions of interest (ROI) placed on the axial ascending thoracic aorta and 10 ROI in the superior vena cava, respectively.Mean aortic TBR was calculated in each patient as the ratio between the average of vascular max SUV and blood mean SUV.Patients with a follow-up of less than one month were excluded.Atherothrombotic events were defined as cardiac death or the apparition of new myocardial, cerebral or limb ischemia or necrosis.Results.Mean age of patients was 67 ±14.4 years; 70 % were male.Following FDG-PET, patients were treated by anti-platelet drugs and statins.After a mean follow-up of 3.5 years, atherothombotic events occured in 27 % of patient.The rate of atherothombotic events increased in parallel with aortic TBR: tertile 1 (TBR: 1.22 -1.57): 20.6 %; tertile 2 (TBR: 1.58 -1.74): 27 %; tertile 3 (TBR: 1.75 -2.31): 32.8 %.Aortic TBR was significantly higher in patients who developed a cardiovascular event vs. remained asymptomatic during follow-up (1.77 ± 0.20 vs. 1.65 ± 0.21; p = 0.005), whereas no difference in aortic TBR was observed in patients who developed neurovascular events vs. asymptomatic patients (1.67 ±0.18 vs. 1.65 ±0.21; p = 0.86).Conclusions.In patients with overt coronary or carotid artery disease, high aortic TBR was associated with an increased risk of cardiovascular but not cerebrovascular events during follow-up.

BACKGROUND After a transient ischemic attack (TIA) or minor stroke, the long-term risk of stroke and other vascular events is not well known. In this follow-up to a report on 1-year outcomes from a registry of TIA clinics in 21 countries that enrolled 4789 patients with a TIA or minor ischemic stroke from 2009 through 2011, we examined the 5-year risk of stroke and vascular events. METHODS We evaluated patients who had had a TIA or minor stroke within 7 days before enrollment in the registry. Among 61 sites that participated in the 1-year outcome study, we selected 42 sites that had follow-up data on more than 50% of their enrolled patients at 5 years. The primary outcome was a composite of stroke, acute coronary syndrome, or death from cardiovascular causes (whichever occurred first), with an emphasis on events that occurred in the second through fifth years. In calculating the cumulative incidence of the primary outcome and secondary outcomes (except death from any cause), we treated death as a competing risk. RESULTS A total of 3847 patients were included in the 5-year follow-up study; the median percentage of patients with 5-year follow-up data per center was 92.3% (interquartile range, 83.4 to 97.8). The composite primary outcome occurred in 469 patients (estimated cumulative rate, 12.9%; 95% confidence interval (CI), 11.8 to 14.1), with 235 events (50.1%) occurring in the second through fifth years. At 5 years, strokes had occurred in 345 patients (estimated cumulative rate, 9.5%; 95% CI, 8.5 to 10.5), with 149 of these patients (43.2%) having had a stroke during the second through fifth years. Rates of death from any cause, death from cardiovascular causes, intracranial hemorrhage, and major bleeding were 10.6%, 2.7%, 1.1%, and 1.5%, respectively, at 5 years. In multivariable analyses, ipsilateral large-artery atherosclerosis, cardioembolism, and a baseline ABM score for the risk of stroke (range, 0 to 7, with higher scores indicating greater risk) of 4 or more were each associated with an increased risk of subsequent stroke. CONCLUSIONS In a follow-up to a 1-year study involving patients who had a TIA or minor stroke, the rate of cardiovascular events including stroke in a selected cohort was 6.4% in the first year and 6.4% in the second through fifth years. (Funded by AstraZeneca and others.)

Les accidents vasculaires cérébraux cryptogéniques présentent une forte prévalence dans la population générale. Les imageries par angioscanner et par TEP-18FDG permettent la détection d’anomalies morphologiques et métaboliques évocatrices de plaques compliquées instables. Le but de cette étude est d’évaluer l’intérêt diagnostique d’une analyse combinée TEP-FDG/angioscanner chez de tels patients (pts). Trente-sept pts avec AVC cryptogénique < 14 jours ont été évalués. Une TEP a été réalisée 2 heures après injection de 4 MBq/kg de FDG, suivie d’un angioscanner des troncs supra-aortiques. Les caractéristiques morphologiques des plaques ont été identifiées sur l’angioscanner. L’intensité de captation du FDG a été exprimée en rapport de fixation tissu/sang (TBR), centrée sur la plaque (TBR max) et en moyennant la valeur du TBR le long de l’artère carotide homolatérale (TBR moyen). Une IRM à haute résolution (IRM-HR) complémentaire a été réalisée chez 13 pts ; 7 pts ont été traités par endartérectomie. Les 37 pts (âge moyen : 67 ± 16 ans) ont été explorés 7 jours (1–15 j) après l’AVC. Trente-sept plaques carotidiennes homolatérales à l’AVC ont été détectées. Les degrés de sténose luminale et d’épaisseur de plaque étaient significativement plus élevés dans les artères homolatérales à l’AVC que controlatérale (respectivement, 40 ± 10 % vs 10 ± 20 % et 3,8 ± 1 mm vs 0,6 ± 0,8 mm, p < 0,001 pour les deux). La prévalence de plaques hypodenses et l’étendue de cette hypodensité étaient significativement plus élevées dans l’artère homolatérale vs controlatérale (49 % vs 22 %, 1,5 ± 1,3 mm2 vs 1,1 ± 0,8 mm2, p < 0,05 pour les deux). Les RTS max et RTS moyen étaient également significativement plus élevés dans les artères carotides homolatérales au territoire de l’AVC vs controlatérales (RTS max : 2,75 ± 1,18 vs 2,05 ± 0,55 ; RTS moyen : 2,20 ± 0,95 vs 1,65 ± 0,52, respectivement, p = 0,000007 et p = 0,0002). La prévalence de plaques non sténosantes hypodenses avec RTSmax > 1,80 était significativement plus élevée dans l’artère carotide homolatérale vs controlatérale (71 % vs 34 % respectivement, p < 0,05). Parmi les pts présentant une plaque hypodense et hypermétabolique, une IRM-HR de la paroi artérielle a été réalisée chez 8 pts et une endartérectomie a été réalisée chez 4 pts, confirmant également dans tous les cas le caractère compliqué de la plaque. Dans cette étude, nous avons retrouvé une prévalence élevée de plaques hypodenses non sténosantes hypermétaboliques (RTSmax > 1,80) dans l’artère carotide homolatérale à l’AVC, suggérant un lien causal entre de telles plaques et la survenue d’AVC de cause inconnue. Comparativement à l’IRM-HR, l’analyse combinée TEP18FDG/angioscanner des plaques carotidiennes présente l’avantage d’être simple et facile à implémenter et autorise une exploration en un temps de l’ensemble des troncs supra-aortiques.