The role of plaque morphology and diameter reduction in the development of new symptoms in asymptomatic carotid arteries

Langsfeld, Mark; Gray-Weale, Anthony C.; Lusby, Robert J.

doi:10.1067/mva.1989.vs0090548

Cited by 96 publications

(81 citation statements)

References 19 publications

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“…Their work revealed that a large proportion of atherosclerotic lesions obtained from patients with symptomatic carotid artery stenoses had complicated atherosclerotic plaques, predominantly due to IPH. Some followup studies have confirmed this finding [21][22][23][24][25]. However, other investigators have failed to find an association between the presence of IPH and carotid territory symptoms [26][27][28].…”

Section: Discussionsupporting

confidence: 50%

Increased internal carotid artery peak systolic velocity is associated with presence of significant atherosclerotic plaque instability independent of degree of ICA stenosis

et al. 2011

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The aim of our work was to study the relationship between Doppler ultrasound velocity measurements and the presence of histologic features of plaque instability in carotid atherosclerosis, in particular, intraplaque hemorrhage (IPH). Consecutive patients undergoing carotid endarterectomy in a one-year period were included. All patients were examined by duplex ultrasonography and carotid angiography. Endarterectomy specimens were examined histologically for features of plaque instability. The quantity of IPH was measured by digital image analysis. The associations between Peak Systolic Velocity (PSV), end-diastolic velocity (EDV), degree of ICA stenosis, shape and length of the lesion and the features of plaque instability and quantity of IPH were assessed. Seventy-four patients (20 asymptomatic, 54 symptomatic) were included. PSV was independently associated with the presence of significant IPH [p < 0.001, OR = 1.04 (95% CI = 1.01-1.06)], as was the degree of angiographic ICA stenosis [p < 0.05, OR = 0.98 (95% CI = 0.92-1.6)]. Neither EDV nor the shape of the lesion was associated with IPH ( p = 0.26 and p = 0.38, respectively). A close correlation was observed between PSV and the quantity of IPH (r 2 = 0.68, p < 0.0001). A significant association was observed between PSV and the presence of plaque ulceration (p < 0.05); however, this was not found to be independent of the quantity of IPH and the degree of ICA stenosis [p = 0.17, OR = 1.28 (95% CI = 0.6-2.44)]. PSV at the site of ICA stenosis appears to be associated with the quantity of intraplaque hemorrhage, independent of the angiographic degree of ICA stenosis. We propose that the role of Doppler velocity measurements extends beyond measurement of the degree of ICA stenosis. Increased ICA peak systolic velocity by itself may be an indicator of atherosclerotic plaque instability.

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Section: Discussionsupporting

confidence: 50%

Increased internal carotid artery peak systolic velocity is associated with presence of significant atherosclerotic plaque instability independent of degree of ICA stenosis

et al. 2011

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“…Initial studies of plaque echogenicity with B-mode ultrasound reported an association between heterogeneous plaques and the occurrence of cerebrovascular events [29, 30, 31, 32, 33]. Support for this association was provided by several investigations of endarterectomy specimens which suggested a correlation between intraplaque haemorrhage and transient ischaemic attacks and stroke [34, 35, 36, 37].…”

Section: Plaque Development – the Intermediate Stagementioning

confidence: 86%

Ultrasound and Arterial Wall Disease

Hennerici¹,

Baezner²,

Daffertshofer³

2003

Cerebrovasc Dis

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Rapid progress in non-invasive ultrasound techniques has resulted in a wide variety of clinical applications for the assessment of cerebrovascular diseases. Recent highlights in ultrasound research include the evaluation of vascular ageing as a degenerative process, the demonstration of plaque development, motion and vulnerability in atherosclerosis and multi-dimensional as well as innovative imaging techniques (e.g., compound imaging) to depict early and small vascular lesions. In addition, echo-contrast agents have been used to compensate for difficulties in visualising late, severe or subtotal obstructive plaques, but failed to be really superior to conventional techniques as evidenced in a prospective, multi-centre trial (Contrast Enhanced Duplex sonography versus Arteriography Studies – CEDAS). With increasing sophistication of ultrasound methodology, it becomes essential to establish standards for data acquisition and interpretation: three consensus meetings have provided detailed recommendations on quantification of carotid atherosclerosis, characterisation of carotid artery plaques and detection of microembolism by transcranial Doppler as a potential indicator of stroke risk.

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“…Currently, anechoic or hypoechoic plaques are believed to be related to intraplaque haemorrhage or lipid deposits within the plaque and are associated with an increased risk of stroke [15]. Calcified plaques are generally stable and are found in asymptomatic patients [16]. Irregular or ulcerated plaques can act as a nidus for emboli which can cause transient ischaemic attack or cerebrovascular accidents [17].…”

Section: Discussionmentioning

confidence: 99%

Sonographic Characterisation of Radiation-Induced Carotid Artery Stenosis

Lam

Liu

Leung³

et al. 2002

Cerebrovasc Dis

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Background and Purpose: To study the distribution, extent and sonographic characterisation of radiation-induced carotid artery stenosis in nasopharyngeal carcinoma (NPC) patients. Methods: The distribution of plaques, the extent of stenosis, and the sonographic characterisation of the plaque at maximum stenosis were recorded in 71 NPC patients. The results were compared with the ultrasound results of a control group of 142 patients presenting with symptoms of cerebrovascular disease or carotid bruit. Results: NPC patients had a higher incidence of carotid stenosis (77 vs. 50.7%). The common carotid arteries were most commonly affected by radiation-induced stenosis (93/142 vs. 37/284 in the control group), whereas the carotid bulb was the most commonly affected (56/284) site in the control group. Significantly more NPC patients had moderate-to-severe stenosis (21/71 vs. 27/142). Analysis of the sonographic appearance of radiation-induced and atherosclerotic plaques showed more diffuse involvement in the post-radiation group. Non-calcified plaques and intraplaque hypoechoic foci were also more frequent in the post-radiation group. Conclusions: Radiation-induced carotid stenosis is more diffuse in distribution, is associated with more severe luminal stenosis and has different sonographic plaque characterisation compared with carotid stenosis without radiation exposure.

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The role of plaque morphology and diameter reduction in the development of new symptoms in asymptomatic carotid arteries

Cited by 96 publications

References 19 publications

Increased internal carotid artery peak systolic velocity is associated with presence of significant atherosclerotic plaque instability independent of degree of ICA stenosis

Increased internal carotid artery peak systolic velocity is associated with presence of significant atherosclerotic plaque instability independent of degree of ICA stenosis

Ultrasound and Arterial Wall Disease

Sonographic Characterisation of Radiation-Induced Carotid Artery Stenosis

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