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[Carotid atherosclerosis and thrombotic stroke. Diagnostic and therapeutic perspectives]
U Oliviero1, L Iasiuolo, G La Pastina
1Cattedra di Medicina Interna, Università degli Studi Federico II, Napoli.
Insights
Color-Doppler ultrasonography identifies high-risk carotid plaques for stroke. Surgical intervention is recommended for specific plaque characteristics, while others are managed with lifestyle changes and antithrombotic therapy.
Area of Science:
- Vascular Medicine
- Neurology
- Medical Imaging
Background:
- Carotid atherosclerotic lesions are a significant risk factor for cerebrovascular ischemic events.
- Color-Doppler ultrasonography is a key diagnostic tool for evaluating carotid plaques.
Purpose of the Study:
- To identify ultrasonographic characteristics of carotid plaques associated with high risk of cerebrovascular events.
- To guide therapeutic strategies based on plaque morphology and stenosis degree.
Main Methods:
- Utilized color-Doppler ultrasonography to analyze carotid plaques.
- Correlated ultrasonographic findings (irregular surface, stenosis >70%, intimal hemorrhage, ulceration) with clinical risk.
Main Results:
- Ultrasonography identified specific plaque features (irregular surface, >70% stenosis, intimal hemorrhage, ulceration) indicative of high cerebrovascular event risk.
- These high-risk plaques warrant consideration for surgical intervention (carotid endarterectomy).
- Other lesions are managed with lifestyle modifications, risk factor correction, and antithrombotic therapy.
Conclusions:
- Ultrasonographic patterns of carotid plaques can stratify risk for cerebrovascular events.
- Specific ultrasonographic findings guide the decision between surgical intervention and conservative medical management.
- The precise mechanism of benefit from antiplatelet therapy in carotid atherosclerosis requires further investigation.
Abstract:
Carotid atherosclerotic lesions can be studied with color-Doppler ultrasonography vascular systems. Ultrasonography of the carotid plaques at major risk for the development of cerebrovascular ischemic events showed the following characteristics: irregular surface, degree of stenosis > 70%, intimal hemorrhage and ulceration. The plaques with these ultrasonography patterns have to be considered for surgical approach (TEA). The other patients with carotid atherosclerotic lesions will be initially treated with diet and changes of life style to obtain the correction of cardiovascular risk factors (i.e. hypertension, hypercholesterolemia, diabetes). Furthermore, medical therapy with antithrombotic agents will be instituted which, used with good results also in acute cerebral stroke, proved to be effective in the reduction of vascular events in patients with extracranial atherosclerotic plaques. However, it has not been clarified if the positive effect of antiaggregation therapy in carotid atherosclerosis is due to the inhibition of the progression and plaque growth or if other hemorheological factors are involved.