Carotid plaque characteristics and presenting symptom

Golledge, Jonathan; Cuming, R.; Ellis, Mary; Davies, Alun H.; Greenhalgh, Roger M.

doi:10.1046/j.1365-2168.1997.02846.x

Cited by 48 publications

(41 citation statements)

References 16 publications

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“…[1][2][3] Few studies have quantified the association between carotid plaques and risk of subsequent stroke in asymptomatic subjects. 4,5 Also, limited information is available on the relationship with subtypes of cerebral infarction 4,5 as well as on the impact of location of the carotid plaque in relation to the risk of stroke.…”

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confidence: 99%

Carotid Plaques Increase the Risk of Stroke and Subtypes of Cerebral Infarction in Asymptomatic Elderly

et al. 2002

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Background-Few studies have quantified the relation between carotid plaques and stroke in asymptomatic patients, and limited data exist on the importance of location of plaques or the association with subtypes of cerebral infarction. We investigated the relationship between carotid plaques, measured at different locations, and risk of stroke and subtypes of cerebral infarction in a population-based study. Methods and Results-The study was based on the Rotterdam Study and included 4217 neurologically asymptomatic subjects aged 55 years or older. Presence of carotid plaques at 6 locations in the carotid arteries was assessed at baseline. Severity was categorized according to the number of affected sites. After a mean follow-up of 5.2 years, 160 strokes had occurred. Data were analyzed using Cox proportional hazards regression. Plaques increased the risk of stroke and cerebral infarction Ϸ1.5-fold, irrespective of plaque location. Severe carotid plaques increased the risk of nonlacunar infarction in anterior (RR 3.2 [95% CI, 1.1 to 9.7]) but not in posterior circulation (RR 0.6 [95% CI, 0.1 to 4.9]). A Ͼ10-fold increased risk of lacunar infarction was found in subjects with severe plaques (RR 10.8 [95% CI, 1.7 to 69.7]). No clear difference in risk estimates was seen between ipsilateral and contralateral infarction. Conclusions-Carotid plaques increase the risk of stroke and cerebral infarction, irrespective of their location. Plaques increase the risk of infarctions in the anterior but not in the posterior circulation. It is likely that carotid plaques in neurologically asymptomatic subjects are both markers of generalized atherosclerosis and sources of thromboemboli.

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confidence: 99%

Carotid Plaques Increase the Risk of Stroke and Subtypes of Cerebral Infarction in Asymptomatic Elderly

et al. 2002

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“…7) Plaque morphology is another factor associated with increased risk of stroke. 1,2,6) For example, echolucent plaque is significantly more common in symptomatic patients than in asymptomatic patients. 6) Other studies have also suggested an association between echolucent plaque and the subsequent development of neurologic symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,6) For example, echolucent plaque is significantly more common in symptomatic patients than in asymptomatic patients. 6) Other studies have also suggested an association between echolucent plaque and the subsequent development of neurologic symptoms. 1,2) In the present patients, preoperative cerebral angiography and carotid echography revealed ulceration and echolucent plaque in the affected carotid artery, which was confirmed by postoperative macroscopic examination findings of ulcerated plaque with thrombi.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4]6,7) For example, plaque ulceration with symptomatic high-grade stenosis is associated with a several-fold increased risk of stroke. 4) Although plaque ulceration is usually detected in large highgrade carotid lesions, ulcers are sometimes found in early carotid atheroma (7% of low-grade stenosis).…”

Section: Discussionmentioning

confidence: 99%

“…5,10) Certain carotid plaque characteristics, including the morphology and surface, are also associated with a high risk of stroke. [1][2][3][4]6,7) Endarterectomy is an effective method for preventing stroke in patients with severe carotid stenosis (À70%), but the efficacy of the procedure for mild carotid stenosis (º50%) remains uncertain, regardless of the carotid plaque characteristics. 9) We treated two patients by carotid endarterectomy (CEA) for unilateral cervical carotid artery stenosis of less than 50% with plaque ulceration who suffered from recurrent ischemic stroke events despite treatment with antiplatelet and anticoagulation drugs.…”

Section: Introductionmentioning

confidence: 99%

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Endarterectomy for Mild Cervical Carotid Artery Stenosis in Patients With Ischemic Stroke Events Refractory to Medical Treatment -Two Case Reports-

Kobayashi

Ogasawara

Inoue

et al. 2008

Neurol. Med. Chir.(Tokyo)

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A 62-year-old man and a 44-year-old man with unilateral cervical carotid artery stenosis (less than 50% with echolucent plaque and ulceration) suffered recurrent ischemic stroke events despite treatment with antiplatelet and anticoagulation drugs. Carotid endarterectomy (CEA) was performed under transcranial Doppler monitoring for the detection of micro-emboli using a microscope inserted through a skin incision to minimize pressure on the carotid arteries. The atheroma plaque included an ulcer with fresh thrombi in both patients. Both patients awoke from anesthesia without new neurological deficits, and no ischemic stroke events have recurred since CEA. Endarterectomy is an effective method for preventing stroke in patients with severe carotid stenosis (À70%), but the efficacy of this procedure for mild carotid stenosis (º50%) remains uncertain, regardless of carotid plaque characteristics. The present cases suggest that even mild stenosis of the cervical carotid artery may result in ischemic stroke events that are refractory to medical treatment if the stenosis is associated with echolucent plaque with ulceration. Endarterectomy is recommended to prevent further stroke in such patients.

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