Carotid Plaque Area

Abstract

Background and Purpose-Carotid plaque area measured by ultrasound (cross-sectional area of longitudinal views of all plaques seen) was studied as a way of identifying patients at increased risk of stroke, myocardial infarction, and vascular death. Methods-Patients from an atherosclerosis prevention clinic were followed up annually for up to 5 years (mean, 2.5Ϯ1.3 years) with baseline and follow-up measurements recorded. Plaque area progression (or regression) was defined as an increase (or decrease) of Ն0.05 cm 2 from baseline. Results-Carotid plaque areas from 1686 patients were categorized into 4 quartile ranges: 0.00 to 0.11 cm 2 (nϭ422), 0.12 to 0.45 cm 2 (nϭ424), 0.46 to 1.18 cm 2 (nϭ421), and 1.19 to 6.73 cm 2 (nϭ419). The combined 5-year risk of stroke, myocardial infarction, and vascular death increased by quartile of plaque area: 5.6%, 10.7%, 13.9%, and 19.5%, respectively (PϽ0.001) after adjustment for all baseline patient characteristics. A total of 1085 patients had Ն1 annual carotid plaque area measurements: 685 (63.1%) had carotid plaque progression, 306 (28.2%) had plaque regression, and 176 (16.2%) had no change in carotid plaque area over the period of follow-up. The 5-year adjusted risk of combined outcome was 9.4%, 7.6%, and 15.7% for patients with carotid plaque area regression, no change, and progression, respectively (Pϭ0.003). Conclusions-Carotid plaque area and progression of plaque identified high-risk patients. Plaque measurement may be useful for targeting preventive therapy and evaluating new treatments and response to therapy and may improve cost-effectiveness of secondary preventive treatment.

Joint Effect of Carotid Plaque and C‐Reactive Protein on First‐Ever Ischemic Stroke and Myocardial Infarction?

“…Carotid ultrasound is noninvasive and easily accessible, and it can provide direct evidence for the presence and extent of subclinical atherosclerosis with the potential for a more accurate personalized risk assessment and treatment approach 31. Ultrasound assessed measures of subclinical atherosclerosis in carotid arteries; plaque presence,32 plaque echogenicity,33, 34 plaque area,35, 36 and IMT37 are reliable predictors of CVD, even after adjustment for TRFs. The European Guidelines on CVD prevention suggest that imaging methods for atherosclerotic burden are relevant, especially in individuals at intermediate risk based on TRFs, to improve cardiovascular risk stratification and preventive strategy 38, 39.…”

Increased Soluble CD137 Levels and CD4+ T‐Cell‐Associated Expression of CD137 in Acute Atherothrombotic Stroke

“…CD137 is expressed by various immune cells, such as activated CD4+ and CD8+ T lymphocytes, natural killer (NK) cells, CD4+CD25+ regulatory T cells (Treg), monocytes, neutrophils, mast cells, eosinophils, and dendritic cells9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 as well as nonimmune cells such as endothelial cells and vascular smooth muscle cells 10. The ligand of CD137 (CD137L) is primarily expressed on antigen‐presenting cells (dendritic cells, monocytes/macrophages, and B cells), human primary T cells22 and cardiac myocytes in myocarditis and aortic tissue in arteritis 23, 24.…”

“…All patients were diagnosed within 24 hours of the onset of symptoms in terms of medical history, clinical examination, and cranial magnetic resonance image (MRI) and magnetic resonance angiography (MRA) scans. Carotid duplex sonography was carried out in all patients, particularly for measuring total plaque area (TPA), as described elsewhere 17, 18. The National Institutes of Health Stroke Scale (NIHSS) was used to assess neurological deficits while taking blood samples.…”

Diabetes, Intracranial Stenosis and Microemboli in Asymptomatic Carotid Stenosis

“…All patients underwent a baseline measurement of total carotid plaque area and extracranial carotid stenosis, as previously described 3 . Briefly, all plaques seen in the common, internal, and external carotids on both sides of the body were measured by duplex sonography.…”

“…The cross-sectional area of each plaque was measured in a longitudinal view in the plane where the plaque area was greatest; the total of the crosssectional areas of all plaques was carotid total plaque area. The use of carotid total plaque area to assess atherosclerotic burden and predict cardiovascular risk has been previously described 13 and validated 3 . Percent stenosis in each carotid artery was measured by converting the peak frequency in each internal carotid artery into percentage stenosis.…”