Ulceration and carotid artery disease.

Wechsler, Lawrence R.

doi:10.1161/01.str.19.5.650

Cited by 46 publications

(23 citation statements)

References 31 publications

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“…13,16 -18 Variation in incidence of carotid plaque ulceration may relate to differing definitions and testing modalities 19 ; hence, the significance of plaque ulceration as a source of artery-toartery embolism remains unclear. MES have been associated with both angiographically 20 -22 and histologically 13 assessed ulceration, and the lack of association between MES and ulceration in this study may be due to the use of the macroscopic inspection technique to describe ulceration.…”

Section: Discussionmentioning

confidence: 99%

Source of Microembolic Signals in Patients With High-Grade Carotid Stenosis

Stork

Kimura

Levi

et al. 2002

Stroke

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Background and Purpose-In patients with both symptomatic and asymptomatic carotid artery stenoses, the relationship between carotid plaque characteristics and transcranial Doppler (TCD)-detected microembolic signals (MES) is unclear. The purpose of this study was to examine the relationship between macroscopically described plaque characteristics and MES in patients undergoing carotid endarterectomy. Methods-Sequential patients scheduled for carotid endarterectomy underwent preoperative 30-minute TCD monitoring of the ipsilateral middle cerebral artery to detect MES. TCD signal analysis, by researchers who were blinded to patient information, was performed offline. Clinical variables of patients and macroscopic carotid plaque features seen at surgery were documented prospectively. Results-Of the 109 patients (74 male, 35 female; mean age, 68.8Ϯ8.7 years) enrolled, 71 had ipsilateral carotid territory symptoms. MES were detected in 27 of all patients (25%). Twenty-two of 71 symptomatic patients (31%) compared with 5 of 38 asymptomatic patients (13%) had MES (Pϭ0.046). Also, symptomatic patients had more emboli (total MES counts) than asymptomatic patients (Pϭ0.010). The presence or absence of MES was not associated with plaque characteristics. Conclusions-Our data do not confirm previous reports of an association between MES and macroscopic plaque characteristics. We hypothesize that smaller platelet aggregates and fibrin clots, which are not detected macroscopically, are the most likely sources of TCD-detected MES. Key Words: carotid endarterectomy Ⅲ carotid stenosis Ⅲ middle cerebral artery Ⅲ ultrasonography, Doppler, transcranial C arotid stenosis is an important cause of ischemic stroke, with artery-to-artery embolism being the most common mechanism. In 1991, the European Carotid Surgery Trial (ECST) and North American Symptomatic Carotid Endarterectomy Trial (NASCET) investigators reported a beneficial effect in favor of carotid endarterectomy (CEA) in recently symptomatic patients with high-grade carotid artery stenosis. 1,2 The reduction in stroke risk is attributed to removal of the cerebral embolic source in most cases.Asymptomatic cerebral microembolic signals (MES) can be detected in patients with carotid stenosis through the use of transcranial Doppler (TCD). 3,4 Several observations suggest that MES detected distal to a high-grade carotid stenosis are due to unstable plaque. MES are more common among patients with recent carotid artery stroke and are more commonly detected among patients with more severe carotid artery narrowing. [5][6][7][8] Moreover, CEA tends to result in a rapid decline of MES, 9,10 suggesting that their temporal source has been removed.The frequency with which MES can be detected may depend on a number of factors such as duration of monitoring and the interval between symptom onset and TCD study. Reported incidence varies from Ϸ12% 11 to 100%. 9 MES may also be related to carotid plaque morphology. Valton et al 12 showed that MES were associated with carotid plaque ulceration on...

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Section: Discussionmentioning

confidence: 99%

Source of Microembolic Signals in Patients With High-Grade Carotid Stenosis

Stork

Kimura

Levi

et al. 2002

Stroke

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“…Nine thromboemboli were obtained from the ICA or MCA of 4 stroke patients by aspiration and were prepared for material characterization. Because debris from atherosclerotic plaques and atrial fibrillation are well documented as important sources of emboli to cause AIS, 22,23 26 atherosclerotic plaques obtained during CEA and 1 atrial appendage were collected. Materials loosely attached to the luminal surface of the plaques and red thrombi found under the fibrous cap were considered potential sources of cerebral emboli and therefore harvested.…”

Section: Collection Of Thrombi From Patientsmentioning

confidence: 99%

Mechanical Characterization of Thromboemboli in Acute Ischemic Stroke and Laboratory Embolus Analogs

Chueh¹,

Wakhloo²,

Hendricks³

et al. 2011

AJNR Am J Neuroradiol

163

130

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“…Plaque ulceration has long been thought to play a major role in the etiology of stroke from ICA disease. 44 Both ultrasound and CTA have shown some efficacy in detecting plaque ulceration. 45 However, neovascularization and inflammatory changes in the plaque are thought to accompany the processes which lead to plaque rupture, andfor a given degree of stenosis -may serve to further stratify acute stroke risk.…”

Section: Plaque Characterizationmentioning

confidence: 99%

Imaging of the carotid arteries: the role of duplex ultrasonography, magnetic resonance arteriography, and computerized tomographic arteriography

et al. 2008

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Stenosis of the internal carotid artery represents a major cause of stroke, with atherosclerosis representing the major pathophysiology of this stenosis. It is estimated that over 700,000 Americans suffer a stroke annually. A prompt and accurate diagnosis of carotid artery disease is critical when planning a therapeutic strategy. Physical examination is inaccurate in determining the presence and severity of carotid artery disease. Therefore, reliable imaging tests which offer little risk to the patient are required.

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Ulceration and carotid artery disease.

Cited by 46 publications

References 31 publications

Source of Microembolic Signals in Patients With High-Grade Carotid Stenosis

Source of Microembolic Signals in Patients With High-Grade Carotid Stenosis

Mechanical Characterization of Thromboemboli in Acute Ischemic Stroke and Laboratory Embolus Analogs

Imaging of the carotid arteries: the role of duplex ultrasonography, magnetic resonance arteriography, and computerized tomographic arteriography

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