The Relationship Between the Angiographic Findings and the Clinical Features of Carotid Artery Plaque

Kim, Dong Ik; Lee, Sun-Joung; Lee, Byung-Boong; Kim, Yong-il; Chung, Chin‐Sang; Seo, Dae-Won; Lee, Kwang-Ho; Ko, Young‐Hyeh; Kim, Duk Kyung; Do, Yongtae; Byun, Hongsik

doi:10.1007/pl00010044

Cited by 19 publications

(21 citation statements)

References 16 publications

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“…Thirty-nine studies used carotid ultrasound* as the imaging modality, 4 used intra-arterial angiography, 31,56,60,77 7 used computer tomography, 37,41,45,64,75,78,79 and 30 used magnetic resonance imaging. † Three studies used other forms of imaging 24,26,89 and some studied more than one imaging modality.…”

Section: Imagingmentioning

confidence: 99%

A Critical Appraisal of the Performance, Reporting, and Interpretation of Studies Comparing Carotid Plaque Imaging With Histology

Lovett¹,

Redgrave²,

Rothwell³

2005

Stroke

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Background and Purpose-Carotid plaque instability is an important determinant of stroke risk. There are now a number of different imaging techniques that provide information on carotid plaque morphology. However, it is unclear how they compare with one another or whether they can reliably assess plaque instability. Studies comparing imaging with pathology have shown highly variable results, even for similar imaging techniques. This may be because of variable pathology techniques rather than differences in imaging. Methods-We performed a systematic review of studies that compared carotid imaging with histology of the excised plaque published between January 1995 and September 2004. We assessed the quality and comparability of these studies. In particular, we determined which histology methods were used and whether observer reproducibility of the histology assessment was reported. Results-Among 73 eligible studies, histological methods were poorly reported and highly variable; 23% reported reproducibility data for imaging and only 12% reported reproducibility data for histology. Of 29 studies that reported quantitative results of blinded comparisons, there were methodological deficiencies and the results were highly variable.No study considered the extent to which the lack of reproducibility influenced the imaging-pathological correlations reported. Conclusions-Pathological correlation in studies of carotid plaque imaging cannot be reliably interpreted or compared because of incomparable and poorly reported histology methods. We make recommendations for the performance, reporting, and interpretation of imaging-pathological correlation studies and highlight the need for consensus guidelines.

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Section: Imagingmentioning

confidence: 99%

A Critical Appraisal of the Performance, Reporting, and Interpretation of Studies Comparing Carotid Plaque Imaging With Histology

Lovett¹,

Redgrave²,

Rothwell³

2005

Stroke

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“…In the NASCET study, in the group of patients who received medical therapy, 30% of patients who had a severe carotid stenosis associated with an ulcerated plaque suffered an ischemic cerebral event within 2 years, whereas only 17% of patients with severe stenosis but no ulcerated plaques had an ischemic cerebral event within 2 years. 4 The presence of ulceration alone represents an important risk for neurologic symptoms, 7 and a high-grade stenosis, combined with plaque ulceration, produces an increased risk of stroke. 4,8 An accurate delineation of plaque morphology is therefore very important.…”

mentioning

confidence: 99%

“…4,8 An accurate delineation of plaque morphology is therefore very important. 7,8 Incidence of ulceration in the carotid artery is variable, ranging from 14% to 68%, [9][10][11][12] and plaque ulceration is significantly more frequent in symptomatic patients. 11,13 Plaque ulceration has been defined as "an intimal defect larger than 1000-m in width, exposing the necrotic core of the atheromatous plaque."…”

mentioning

confidence: 99%

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

Saba

Caddeo²,

Sanfilippo³

et al. 2007

American Journal of Neuroradiology

197

120

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“…Of 4 published studies that have reported some comparison with histological assessment, 21-24 2 provide only qualitative results, 23,24 and 2 reported only comparisons between angiographic ulceration and histological plaque rupture. 21,22 We have therefore performed the largest study of this kind (128 carotid plaques) to determine which of 10 histological features are associated with assessments of plaque ulceration on angiography. We have also investigated the histological significance of plaque surface irregularity and ulcers of different types.…”

mentioning

confidence: 99%

Histological Correlates of Carotid Plaque Surface Morphology on Lumen Contrast Imaging

et al. 2004

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Background-Carotid angiographic plaque surface morphology is a powerful risk factor for stroke and systemic vascular risk. However, the underlying pathology is unclear, and a better understanding is required both to evaluate other forms of carotid imaging and to develop new treatments. Previous studies comparing angiographic plaque surface morphology with pathology have been small and unblinded, and the vast majority assessed only the crude macroscopic appearance of the plaque. We performed the first large study comparing angiographic surface morphology with detailed histology. Methods and Results-Carotid plaque surface morphology was classified as ulcerated, irregular, or smooth on 128 conventional selective carotid artery angiograms from consecutive patients undergoing endarterectomy for severe symptomatic stenosis. Blinded angiographic assessments were compared with 10 histological features recorded on detailed microscopy of the plaque using reproducible semiquantitative scales. Angiographic ulceration was associated with plaque rupture (Pϭ0.001), intraplaque hemorrhage (Pϭ0.001), large lipid core (Pϭ0.005), less fibrous tissue (Pϭ0.003), and increased instability overall (Pϭ0.001). For example, angiographically ulcerated plaques were much more likely than smooth plaques to be ruptured (ORϭ15.4, 95% CIϭ2.7 to 87.3, PϽ0.001), show a large lipid core (ORϭ26.7, 95% CIϭ2.6 to 270, PϽ0.001) or a large hemorrhage (ORϭ17.0, 95% CIϭ2.0 to 147, Pϭ0.02). The equivalent odds ratios for angiographically irregular versus smooth plaque were 6.3 (1.3 to 31, Pϭ0.02), 6.7 (1.5 to 30, Pϭ0.008), and 9.2 (1.1 to 77, Pϭ0.02), respectively. Conclusions-In contrast to previous studies based on macroscopic assessment, we found very strong associations between detailed histology and carotid angiographic plaque surface morphology. Plaque surface morphology on carotid angiography is a highly sensitive marker of plaque instability. Studies of the predictive value of MR-and CT-based lumen contrast plaque surface imaging are required.

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The Relationship Between the Angiographic Findings and the Clinical Features of Carotid Artery Plaque

Cited by 19 publications

References 16 publications

A Critical Appraisal of the Performance, Reporting, and Interpretation of Studies Comparing Carotid Plaque Imaging With Histology

A Critical Appraisal of the Performance, Reporting, and Interpretation of Studies Comparing Carotid Plaque Imaging With Histology

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

Histological Correlates of Carotid Plaque Surface Morphology on Lumen Contrast Imaging

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