{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T07:09:21Z","timestamp":1774076961977,"version":"3.50.1"},"reference-count":29,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Stroke Vasc Neurol"],"accepted":{"date-parts":[[2017,2,2]]},"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>ABCD<jats:sup>2<\/jats:sup> risk score and cerebral microemboli detected by transcranial Doppler (TCD) have been separately shown to the predict risk of recurrent acute stroke. We studied whether ABCD<jats:sup>2<\/jats:sup> risk score predicts cerebral microemboli in patients with hyper-acute symptomatic carotid artery stenosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants and methods<\/jats:title>\n                  <jats:p>We studied 206 patients presenting within 2\u2005weeks of transient ischaemic attack or minor stroke and found to have critical carotid artery stenosis (\u226550%). 86 patients (age 70\u00b11 (SEM: years), 58 men, 83 Caucasian) had evidence of microemboli; 72 (84%) of these underwent carotid endarterectomy (CEA). 120 patients (age 72\u00b11\u2005years, 91 men, 113 Caucasian) did not have microemboli detected; 102 (85%) of these underwent CEA. Data were analysed using <jats:italic>X<\/jats:italic>\n                     <jats:sup>2<\/jats:sup> and Mann\u2013Whitney U tests and receiver operating characteristic (ROC) curves.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>140\/206 (68%: 95% CI 61.63 to 74.37) patients with hyper-acute symptomatic critical carotid stenosis had an ABCD<jats:sup>2<\/jats:sup> risk score \u22654. There was no significant difference in the NICE red flag criterion for early assessment (ABCD<jats:sup>2<\/jats:sup> risk score \u22654) for patients with cerebral microemboli versus those without microemboli (59\/86 vs 81\/120 patients: OR 1.05 ABCD<jats:sup>2<\/jats:sup> risk score \u22654 (95% CI 0.58 to 1.90, p=0.867)). The ABCD<jats:sup>2<\/jats:sup> risk score was &lt;4 in 27 of 86 (31%: 95% CI 21 to 41) embolising patients and in 39 of 120 (31%: 95% CI 23 to 39) without cerebral microemboli. After adjusting for pre-neurological event antiplatelet treatment (APT), area under the curve (AUC) of ROC for ABCD<jats:sup>2<\/jats:sup> risk score showed no prediction of cerebral microemboli (no pre-event APT, n=57: AUC 0.45 (95% CI 0.29 to 0.60, p=0.531); pre-event APT, n=147: AUC 0.51 (95% CI 0.42 to 0.60, p=0.804)).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The ABCD<jats:sup>2<\/jats:sup> score did not predict the presence of cerebral microemboli or carotid disease in over one-quarter of patients with symptomatic critical carotid artery stenosis. On the basis of NICE guidelines (refer early if ABCD<jats:sup>2<\/jats:sup> \u22654), assessment of high stroke risk based on ABCD<jats:sup>2<\/jats:sup> scoring may lead to inappropriate delay in urgent treatment in many patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/svn-2017-000073","type":"journal-article","created":{"date-parts":[[2017,3,17]],"date-time":"2017-03-17T22:58:00Z","timestamp":1489791480000},"page":"41-46","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["ABCD<sup>2<\/sup> risk score does not predict the presence of cerebral microemboli in patients with hyper-acute symptomatic critical carotid artery stenosis"],"prefix":"10.1136","volume":"2","author":[{"given":"Mahmud","family":"Saedon","sequence":"first","affiliation":[{"name":"Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles E","family":"Hutchinson","sequence":"additional","affiliation":[{"name":"Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher H E","family":"Imray","sequence":"additional","affiliation":[{"name":"Warwick Medical School, University of Warwick, Coventry, UK"},{"name":"University Hospitals Coventry Warwickshire NHS Trust, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald R J","family":"Singer","sequence":"additional","affiliation":[{"name":"Warwick Medical School, University of Warwick, Coventry, UK"},{"name":"Fellowship of Postgraduate Medicine, London, UK"},{"name":"Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,3,17]]},"reference":[{"key":"2025081709293162000_2.2.41.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(07)70274-0"},{"key":"2025081709293162000_2.2.41.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)12228-3"},{"key":"2025081709293162000_2.2.41.3","unstructured":"Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE Clinical Guideline [CG68]. Published: July 2008. Last updated: March 2017. www.nice.org.uk\/guidance\/cg68"},{"key":"2025081709293162000_2.2.41.4","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/118.4.1005"},{"key":"2025081709293162000_2.2.41.5","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.30.7.1440"},{"key":"2025081709293162000_2.2.41.6","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.563056"},{"key":"2025081709293162000_2.2.41.7","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000162717.62684.40"},{"key":"2025081709293162000_2.2.41.8","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(10)70120-4"},{"key":"2025081709293162000_2.2.41.9","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(05)70169-1"},{"key":"2025081709293162000_2.2.41.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60150-0"},{"key":"2025081709293162000_2.2.41.11","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.570010"},{"key":"2025081709293162000_2.2.41.12","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.112.676338"},{"key":"2025081709293162000_2.2.41.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2010.10.017"},{"key":"2025081709293162000_2.2.41.14","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000054671.71777.C7"},{"key":"2025081709293162000_2.2.41.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2008.10.015"},{"key":"2025081709293162000_2.2.41.16","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4030"},{"key":"2025081709293162000_2.2.41.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(98)70359-9"},{"key":"2025081709293162000_2.2.41.18","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.29.3.725"},{"key":"2025081709293162000_2.2.41.19","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1161\/01.STR.30.8.1610","article-title":"Improved automated detection of embolic signals using a novel frequency filtering approach","volume":"30","author":"Markus","year":"1999","journal-title":"Stroke"},{"key":"2025081709293162000_2.2.41.20","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000163561.90680.1C"},{"key":"2025081709293162000_2.2.41.21","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.6204"},{"key":"2025081709293162000_2.2.41.22","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.548032"},{"key":"2025081709293162000_2.2.41.23","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.552042"},{"key":"2025081709293162000_2.2.41.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2012.02.002"},{"key":"2025081709293162000_2.2.41.25","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.560045"},{"key":"2025081709293162000_2.2.41.26","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.571844"},{"key":"2025081709293162000_2.2.41.27","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1159\/000104483","article-title":"Performance of the ABCD and ABCD2 scores in TIA patients with carotid stenosis and atrial fibrillation","volume":"24","author":"Koton","year":"2007","journal-title":"Cerebrovasc Dis"},{"key":"2025081709293162000_2.2.41.28","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(10)70240-4"},{"key":"2025081709293162000_2.2.41.29","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.003077"}],"container-title":["Stroke and Vascular Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/svn-2017-000073","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T16:29:40Z","timestamp":1755448180000},"score":1,"resource":{"primary":{"URL":"https:\/\/svn.bmj.com\/lookup\/doi\/10.1136\/svn-2017-000073"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,3,17]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2017,6,26]]},"published-print":{"date-parts":[[2017,6]]}},"alternative-id":["10.1136\/svn-2017-000073"],"URL":"https:\/\/doi.org\/10.1136\/svn-2017-000073","relation":{},"ISSN":["2059-8688","2059-8696"],"issn-type":[{"value":"2059-8688","type":"print"},{"value":"2059-8696","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,3,17]]}}}