The Influence of Various Morphologic and Hemodynamic Carotid Plaque Characteristics on Neurological Events Onset and Deaths

Abstract

A group of 72 patients with 111 asymptomatic carotid stenoses (ACS), mean age 65.42 ± 9.21, and a group of 36 patients with 58 symptomatic carotid stenoses (SCS), mean age 67.63 ± 8.79, were analyzed prospectively during a 3-year follow-up period. All patients underwent color duplex scan sonography (CDS), carotid arteriography, computed tomography (CT) scan, and neurological examination. The aim of the study was to analyze the correlation between echo plaque morphology (degree and plaque quality), local hemodynamic plaque characteristics, ischemic CT findings, and onset of new neurological events and deaths. The results analysis showed significantly more ACS in the group of 30–49% stenosis (p < 0.001), but significantly more SCS in the group of 70–89% (p < 0.0001) and ≥90% stenosis (p < 0.05). Fibrous plaque was more frequent in the ACS group (p < 0.001), while ulcerated and mixed plaques were more frequent in the SCS group (both p < 0.0001). In the SCS group, a significantly higher frequency of increased peak systolic and end diastolic velocities was noted at the beginning and end of the study (both p < 0.01), as well as for contralateral common (CCA) or internal carotid artery (ICA) occlusion (p < 0.05 and p < 0.01, respectively), but reduced carotid blood flow volume (p < 0.05) only at the end of the study. In the ACS group, the best correlation with new neurological events and deaths was shown with positive CT findings, peak systolic flow velocity over 210 cm/sec, end diastolic flow velocity over 110 cm/sec, plaque stenosis ≥70%, plaque ulceration, mixed plaque (all p < 0.0001); stenosis ≥50% (p < 0.001); and reduced carotid blood flow volume (p < 0.05).

Comparison between Carotid Artery Wall Thickness Measured by Multidetector Row Computed Tomography Angiography and Intimae-Media Thickness Measured by Sonography

“…Numerous studies have shown that an increased IMT is an early marker of generalized atherosclerosis [30,31], and an important predictor of coronary and cerebrovascular complications [2,24,32]. Saba and colleagues [33] demonstrated that the thicker common carotid wall is associated with the development of cerebral ischemic events [37]. Clinically evident cardiovascular disease frequently arises as a late manifestation of widespread atherosclerosis, typically after a long subclinical phase beginning at an early age, and manifests as endothelial damage jointly with a gradual thickening of the IMT [24].…”

“…Our results showed that MDCTA can also provide additional information with the CC-CAWT measurements. In most medical centers, CD-US is the first and frequently a sufficient method for evaluation of stenosis degree, type of plaque, and presence of ulceration; it gives enough data to diminish the risk for patients [37]. MDCTA is not recommended as a routine method [3], but in cases where clinically indicated (according to the guidelines accepted in each institution), CAWT should be always quantified by MDCTA [24,38].…”

Assessment of vulnerable and unstable carotid atherosclerotic plaques on endarterectomy specimens

“…Furthermore, noncalcified carotid plaques commonly exhibit a higher degree of fibrous cap inflammation, a key process in fibrous cap disruption. Calcification in ATS lesions is relatively common and has been implicated as a risk factor for increased cardiovascular morbidity and mortality (8,9), while Bayturan et al (10) and Hashimoto et al (11) demonstrated that carotid ATS plaque calcification is a structural marker for carotid plaque stability.…”

Imaging of the ulcerated carotid atherosclerotic plaque: a review of the literature

“…However, other studies have correlated ulceration with symptoms even in plaques causing low-grade stenosis (≤50%) [ 38 ]. Ulceration is more frequently found in symptomatic carotid plaques [ 39 ] and is also associated with the occurrence of new symptoms in asymptomatic patients [ 40 ]. Indeed, multiparametric analysis has confirmed the correlation of ipsilateral TIA or stroke with the presence of carotid ulceration in asymptomatic prospectively observed patients [ 41 ].…”