Carotid plaque volume in patients undergoing carotid endarterectomy

Abstract

BackgroundThe main indication for carotid endarterectomy (CEA) is severity of carotid artery stenosis, even though most strokes in carotid disease are embolic. The relationship between carotid plaque volume (CPV) and symptoms of cerebral ischaemia, and the measurement of CPV by minimally invasive tomographic ultrasound imaging, were investigated.MethodsThe volume of the endarterectomy specimen was measured using a validated saline suspension technique in patients undergoing CEA. Time from last symptom and severity of stenosis measured by duplex ultrasonography were recorded. Middle cerebral artery emboli were counted using transcranial Doppler imaging (TCD) in a subset of patients.ResultsSome 339 patients were included, 270 with symptomatic and 69 with asymptomatic carotid stenosis. Mean(s.d.) CPV was higher in symptomatic than in asymptomatic patients (0·97(0·43) versus 0.74(0·41) cm3; P < 0·001). CPV did not correlate with severity of carotid stenosis (P = 0·770). Mean CPV was highest at 1·03(0·46) cm3 in the 4 weeks following cerebral symptoms, declining to 0·78(0·36) cm3 beyond 8 weeks. Among 33 patients who had TCD, mean CPV was 1·00(0·48) cm3 in the 27 patients with ipsilateral cerebral emboli compared with 0·67(0·16) cm3 in those without (P = 0·142). There was excellent correlation between CPV measured by tomographic ultrasound imaging and the endarterectomy specimen in 34 patients (r = 0·93, P < 0·001).ConclusionCPV correlated with symptoms of cerebral ischaemia, but not carotid stenosis. It could be a potential indicator for CEA.

Resistance to Antiplatelet Therapy Is Associated With Symptoms of Cerebral Ischemia in Carotid Artery Disease

“…As part of a major study on the importance of carotid plaque volume (CPV) as a cause of cerebral ischemia, 23 we also explored of the role of resistance to aspirin and clopidogrel in patients admitted for carotid endarterectomy. Our aim was to determine whether resistance to platelet-inhibitory therapy related to the number of cerebral emboli detected in the ipsilateral middle cerebral artery (MCA) by TCD pre-operatively and recent symptoms of cerebral ischemia.…”

15-Year Stroke Prevention After Successful Carotid Endarterectomy for Asymptomatic Stenosis: Extended Post-trial Follow-up of Patients in the First Asymptomatic Carotid Surgery Trial (ACST-1)

“…Introduction -Carotid Plaque Volume (CPV) correlates more closely than severity of stenosis with symptoms of cerebral ischemia in patients with carotid disease [1]. If we could measure CPV by a minimally-invasive technique, it may replace severity of stenosis as the principle indication for carotid endarterectomy (CEA) and may even be used for population screening in the future.…”

How Can We Treat Asymptomatic Carotid Disease in Patients with a Planned CABG?

“…Risk stratification for carotid stenosis generally has been based on angiographic or Doppler ultrasonographic examination of luminal stenosis but we need to identify vulnerable carotid plaque by using more sophisticated methods such as positron emission tomography with computed tomography, magnetic resonance imaging (MRI), contrast enhanced ultrasound techniques and detection of micro-embolism using transcranial Doppler (TCD) ultrasound (45)(46)(47)(48)(49)(50) . The pattern of progression of carotid stenosis is unpredictable and it may progress rapidly or slowly or remain stable in long term period (46) .…”

“…Measuring carotid plaque volume (CPV) by minimally invasive tomographic ultrasound imaging and MRI suggested that CPV was associated with cardiovascular risk factors and symptoms of cerebral ischemia (50,51) . Ball et al (50) reported that CPV correlated with symptoms of cerebral ischemia but not carotid stenosis and it could be a potential indicator for CEA.…”

“…Measuring carotid plaque volume (CPV) by minimally invasive tomographic ultrasound imaging and MRI suggested that CPV was associated with cardiovascular risk factors and symptoms of cerebral ischemia (50,51) . Ball et al (50) reported that CPV correlated with symptoms of cerebral ischemia but not carotid stenosis and it could be a potential indicator for CEA. To investigate the association between MR imaging-depicted intraplaque hemorrhage (IPH) in the carotid artery wall and the risk of future ipsilateral cerebrovascular events in men with asymptomatic moderate carotid stenosis, Singh et al (52) reported that MR-depicted IPH was associated with an increased risk of cerebrovascular events (HR=3.59 CI=2.4-4.7, negative predictive value=100%).…”