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Cerebral ischemic disease and morphometric analyses of carotid plaques
A D Montauban van Swijndregt1, H R Elbers, F L Moll
1Department of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Insights
Intraplaque hemorrhage, though common in carotid plaques, is minimal in amount. This study questions its direct role in causing neurological symptoms, suggesting plaque composition like fibrosis is more significant.
Area of Science:
- Cardiovascular Research
- Neurology
- Pathology
Background:
- Atherosclerotic carotid plaque morphology, particularly intraplaque hemorrhage, is suspected to correlate with neurological symptoms.
- Previous research primarily focused on the presence rather than the quantity of intraplaque hemorrhage in symptomatic versus asymptomatic patients.
Purpose of the Study:
- To quantify the amount of intraplaque hemorrhage in carotid endarterectomy specimens.
- To investigate the relationship between plaque composition (fibrosis, lipids, hemorrhage, calcification, thrombosis) and neurological symptoms in patients with severe carotid stenosis.
Main Methods:
- Carotid endarterectomy specimens from 33 symptomatic and 14 asymptomatic patients with >70% luminal stenosis were analyzed.
- Plaque components were quantified as percentages of total plaque volume using histological analysis.
Main Results:
- Intraplaque hemorrhage was prevalent in both symptomatic (94%) and asymptomatic (71%) patients.
- The quantity of intraplaque hemorrhage was very small in both groups (0.39% +/- 0.70% symptomatic; 0.37% +/- 1.12% asymptomatic).
- Symptomatic plaques showed higher fibrosis than lipid content, similar to asymptomatic plaques.
Conclusions:
- The minimal amount of intraplaque hemorrhage suggests its direct role in neurological symptoms is questionable.
- Carotid plaques, regardless of symptoms, generally contain more fibrosis than lipids, potentially indicating instability.
Abstract:
Atherosclerotic carotid plaque morphology and especially, intraplaque hemorrhage are assumed to be related to neurological symptoms. Most researchers have only investigated the incidence of intraplaque hemorrhage in symptomatic and asymptomatic patients. In the present study, the amount of intraplaque hemorrhage is determined in carotid endarterectomy specimens from 33 symptomatic and 14 asymptomatic patients that caused >70% luminal stenosis. The plaque components (fibrosis, lipids, intraplaque hemorrhage, calcification, and intraluminal thrombosis) were quantified as a percentage of the total plaque volume. A high incidence of intraplaque hemorrhage was found in both the symptomatic (94%, 31/33) and asymptomatic (71%, 10/14) patients. The amount of intraplaque hemorrhage was very small within the plaques of the symptomatic (0.39% +/- 0.70%) and asymptomatic (0.37% +/- 1.12%) patients. The plaques of the symptomatic patients contained more fibrosis than lipids (45.62% +/- 14.99% and 20.45% +/- 21.45%, respectively), as did the plaques of the asymptomatic patients (42. 51% +/- 15.28% and 15.46% +/- 15.22%, respectively). Finally, intraluminal thrombosis and calcification were rare. We conclude that the amount of intraplaque hemorrhage was very small and therefore question its direct role in the development of neurological symptoms. In general, the "unstable" plaque contained more fibrosis than lipids.