Characterization of symptomatic and asymptomatic carotid plaques using high-resolution real-time ultrasonography

Abstract

High-resolution ultrasonography was used to classify carotid plaques into five different types in 72 patients with symptoms and in 49 without, and with stenosis of the origin of the internal carotid artery > 70 per cent. There were 72 plaques in the symptomatic group and 75 in the asymptomatic group. Type 1 plaques were uniformly echolucent, type 2 predominantly echolucent, type 3 predominantly echogenic, type 4 uniformly echogenic and type 5 consisted of plaques that could not be classified owing to heavy calcification and acoustic shadows. Type 1 plaque was found in 90 per cent of patients with symptoms and in 10 per cent of those without, type 2 plaque was found in 53 and 47 per cent, type 3 in 34 and 66 per cent, and type 4 in 5 and 95 per cent, respectively. The preponderance of echolucent plaques in symptomatic patients with stenosis > 70 per cent supports the hypothesis that this type of plaque is unstable and tends to embolize. In contrast, in patients without symptoms there is preponderance of echogenic plaques.

CT and Ultrasound in the Study of Ulcerated Carotid Plaque Compared with Surgical Results: Potentialities and Advantages of Multidetector Row CT Angiography

“…Furthermore, we demonstrated that ulcerations are much more common in fatty versus calcified plaques and confirmed the results of Walker et al 18 The relationship between plaque morphology and clinical behavior in the carotid circulation has been incompletely studied, but it has been demonstrated that cerebral infarcts are more frequent in patients with a lipid core than in patients without a lipid core. 33 The presence of a lipid core is significantly associated with cerebral infarction on MR imaging, and particular centrum semiovale infarcts are more frequent than cortical ones. Indeed, calcified carotid artery atherosclerotic plaques are less symptomatic than those that are noncalcified.…”

“…To assess the plaque echogenicity we used the Gray-Weale classification as modified by Geroulakos 32,33 : type 1 (anechogenic with echogenic fibrous cap), type 2 (predominantly anechogenic but with echogenic areas representing Ͻ25% of the plaque), type 3 (predominantly hyperechogenic but with anechogenic areas representing Ͻ25% of the plaque), type 4 (echogenic and homogeneous plaque), and type 5 (unclassified plaques reflecting calcified plaques with areas of acoustic shadowing, which hide the deeper part of the arterial layers). We defined the plaque surface as regular and smooth, irregular if we observed variation between 0.3 and 0.9 mm on the contour of the plaque, and ulcerated if we observed an irregularity or break in the surface of the plaque with a depth of Ն1 mm.…”

Imaging of the Carotid Artery Vulnerable Plaque

“…One of the most used method is the Gray-Weale's classification modified by Geroulakos [60] that classifies the plaque in five types according to the level of echogenicity: type 1 (anechogenic with echogenic FC); type 2 (predominantly anechogenic but with echogenic areas representing less than 25 % of the plaque); type 3 (predominantly hyperechogenic but with anechogenic areas representing less than 25 % of the plaque); type 4 (echogenic and homogeneous plaque); and type 5 (unclassified plaques reflecting calcified plaques with areas of acoustic shadowing which hide the deeper part of the arterial layers). It was demonstrated that types 1 and 2 are similar to CT fatty plaques, types 3 and 4 as mixed plaques, and type 5 as calcified plaques [61,62] (Fig.…”

Computer aided diagnosis of Coronary Artery Disease, Myocardial Infarction and carotid atherosclerosis using ultrasound images: A review

“…The ability of a particular treatment to prevent stroke, in both symptomatic and asymptomatic patients having chronic carotid stenosis, is the topic of ongoing research [89,90,91]. Figure 1a shows a US scan of the dangerous systematic plaque.…”