The correlation of ultrasonic carotid plaque morphology and carotid plaque hemorrhage: clinical implications

AbuRahma, Ali F.; Kyer, Paul D.; Robinson, Patrick; Hannay, R. Scott

doi:10.1067/msy.1998.91488

Cited by 71 publications

(28 citation statements)

References 18 publications

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“…We excluded 17 that were validation studies comparing plaque imaging with histology [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] ; 7 that failed to provide sufficient data for each group 25,26,50 -54 ; 4 that were highly selected studies 19,[55][56][57] ; 2 that included patients with extracranial restenosis 58,59 ; and 8 that were duplicate records. 1,3,5,14,21,60 -62 The group sizes were very different in 1 study.…”

Section: Resultsmentioning

confidence: 99%

Correlation Between Carotid Intraplaque Hemorrhage and Clinical Symptoms

Gao

Chen

Bao

et al. 2007

Stroke

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Background and Purpose-We sought to investigate the association between carotid intraplaque hemorrhage (IPH) and ipsilateral symptoms of cerebral ischemia. Methods-A search was performed for clinical observational studies comparing the incidence of IPH between symptomatic and asymptomatic patients. Odds ratios (ORs) for IPH as a factor in the pathogenesis of neurologic events were calculated and combined by a meta-analysis. Interstudy heterogeneity, estimated effects, and methodologic quality of the studies were assessed. Results-Thirty-one studies were included for analysis. The reported ORs varied widely. Overall, the incidence of IPH in the symptomatic groups was significantly higher than in the asymptomatic group. However, there was an apparent trend for heterogeneity (PϽ0.00001) between studies. The random-effects summary estimator of ORs was 2.25 (95% CI, 1.57 to 3.22; PϽ0.00001). To identify potential sources of heterogeneity, subgroup analyses were performed. The pooled ORs varied greatly by stratification. Major heterogeneity was found among studies with low quality, microscopic methods of examination, significant effects, small sizes, early publication, and unequal severity of carotid stenosis in both groups. Large, recent, macroscopic, or high-quality studies, as well as studies with equal degrees of stenosis, tended to yield insignificant associations. The methods in defining and evaluating hemorrhage were very heterogeneous. Characterizations of the age, size, number, and location of hemorrhages were poorly reported and highly variable. In addition, a lack of control of confounders and selection bias were frequently identified among studies. Conclusions-Statistical inferences have suggested a plausible role in the production of cerebral ischemia; however, reliable interpretation was strongly undermined by poor methodologic quality, substantial heterogeneity, and suspicious publication bias. To preciously estimate the underlying correlation, a well-designed study with uniformity in definition and evaluation for IPH might be warranted.

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Section: Resultsmentioning

confidence: 99%

Correlation Between Carotid Intraplaque Hemorrhage and Clinical Symptoms

Gao

Chen

Bao

et al. 2007

Stroke

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“…14 AbuRahma, et al, 1 conducted an ultrasonography study of plaque morphology and investigated the clinical implications. They found that 84% of patients…”

Section: Discussionmentioning

confidence: 99%

Procedure complications of carotid angioplasty and stent placement without cerebral protection devices

Kadkhodayan¹,

Derdeyn²,

Cross³

et al. 2005

FOC

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Object The goal in this retrospective study was to examine the procedural complication rate for carotid angioplasty and stent placement performed without cerebral protection devices. Methods Between March 1996 and December 2003, 167 carotid angioplasty and/or stent placement procedures were performed without cerebral protection devices in 152 patients (57 women and 95 men whose mean age was 64 years, range 19–92 years). Seven of these patients underwent angioplasty alone. Eighty-nine patients presented with focal neurological symptoms. Indications for surgery included atherosclerosis, radiation-associated stenosis, dissection, pseudoaneurysm, and stretched endovascular coils from aneurysm treatment. In this study, the patients' medical records were reviewed for clinical characteristics, techniques used, and resulting intraprocedural and 30-day complication rates. The intraprocedural stroke rate was four (2.4%) of 167; this included three hemispheric strokes and one retinal embolus. All events occurred in patients who had symptomatic stenosis. The procedural transient ischemic complication rate was six (3.6%) of 167, as was the procedural nonneurological complication rate. During the 30 days post-procedure, one patient had died and three had suffered permanent ischemic events (two cerebral and one ocular). The composite 30-day postprocedural stroke and death rate was eight (5%) of 160. The rate of asymptomatic angiographically confirmed abnormalities was 0.6% (one treated vessel that was occluded but asymptomatic). The 30-day rate of nonneurological complications was 2.5%. A strong association between intraprocedural thromboembolic events (eight cases) and prior ischemic symptoms was found (p = 0.01). Conclusions Carotid angioplasty and stent placement without cerebral protection devices is safe, particularly in patients without symptomatic stenosis.

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“…19,[25][26][27] Several classification systems have been used to grade the composition of carotid plaque. 19,28 However, there are several problems with this approach.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography Angiography for the Evaluation of Carotid Atherosclerotic Plaque

Walker

Ismail

McMeekin

et al. 2002

Stroke

118

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Background and Purpose-The goal of this study was to determine the efficacy of CT angiography for the characterization of plaque morphology and composition in carotid atherosclerotic disease. Methods-Fifty-five patients undergoing carotid endarterectomy were imaged preoperatively with single-slice spiral CT angiography. One hundred sixty-five endarterectomy sections were examined histologically at selected levels through the distal common and proximal internal carotid arteries. Plaque density was measured (in Hounsfield units) on axial CT sections, and the presence or absence of ulceration was noted. These observations were compared with the histological findings at corresponding levels. Data were analyzed with 2-sample t tests and 1-way analysis of variance (ANOVA). Results-ANOVA testing showed a statistically significant decrease in CT attenuation values with increasing plaque lipid but with a very high standard deviation of values. No other histological factor showed a statistically significant link with CT attenuation. Plaque ulceration was detected by CT with a sensitivity of 60% and a specificity of 74%. Conclusions-Analysis

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The correlation of ultrasonic carotid plaque morphology and carotid plaque hemorrhage: clinical implications

Cited by 71 publications

References 18 publications

Correlation Between Carotid Intraplaque Hemorrhage and Clinical Symptoms

Correlation Between Carotid Intraplaque Hemorrhage and Clinical Symptoms

Procedure complications of carotid angioplasty and stent placement without cerebral protection devices

Computed Tomography Angiography for the Evaluation of Carotid Atherosclerotic Plaque

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