To investigate the clinical significance of lucent defects in computed tomography (CT) scans of the cervical carotid artery plaque, we studied 95 patients with recent symptoms of hemispheric ischemia. Using multiple linear regression analysis, we estimated the strength of the association of symptoms with laterality of carotid artery lucent lesions, stenoses, and ulcerations observed in CT scans. Hemispheric symptoms correlated strongly with ipsilateral carotid lucent lesions (partial p<0.025) and with ipsilateral severe (> 75%) carotid stenosis (partial p< 0.025). Carotid artery ulcerations had a weaker association (partial p<0.1), and stenoses of mild and moderate degrees showed none. The overall performance of all three plaque complications was highly significant (p< 0.005). The lucent defect indicates a morphologic change in the carotid plaque that plays an important role in the development of symptoms of hemispheric ischemia. This is in agreement with the notion that the lucent defect is the image of intraplaque hemorrhage and/or necrosis, which are complications central to the development of symptomatic carotid disease. (Stroke 1988;19:723-727) H igh-resolution computed tomography (CT) of the cervical region permits a low-risk evaluation of the carotid vessels and atheromatous plaque formations, including intramural and extramural histopathologic plaque complications.112 In contrastenhanced cervical CT images, carotid vessels are located immediately lateral and posterior to the pharyngeal cavity and medial to the sternocleidomastoid muscle ( Figure 1). The internal carotid artery is usually found lateral and posterior to the external carotid, although occasional variations occur. In normal individuals, CT images of the vascular wall merge with the image of the contrast-filled lumen and are not observed as a distinct structure. Carotid atheromatous plaques are identified by the irregular, often constricted and commonly calcified contour of the vascular wall, encircling a contrast-filled lumen. Irregularities are more prominent at the carotid bifurcation or in the proximal segment of the internal carotid artery. In CT images of the cervical carotid plaque, it is possible to identify extramural morphologic changes such as stenosis, ulceration, and occlusion, as well as intramural lesions manifested by hyperdense changes indicative of calcification, and lucent, hypodense defects (Figures 2 and 3). Lucencies indicate an intraplaque histologic change that can be observed only by CT. They are suggestive of arterial subintimal hemorrhage or plaque necrosis, which are both complications that play an important role in the development of cerebral ischemia. Should that be the case, plaque lucencies could serve as markers or predictors of risk of stroke. Received September 14, 1987; accepted December 4, 1987. To investigate the clinical significance of intramural lucent defects observed in contrast-enhanced CT images of the cervical carotid plaque, we studied patients with symptoms of hemispheric ischemia. The streng...
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