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Hemispheric symptoms and carotid plaque echomorphology
M M Sabetai1, T J Tegos, A N Nicolaides
1Department of Vascular Surgery, Irvine Laboratory for Cardiovascular Investigation , London, United Kingdom.
Journal of Vascular Surgery
|January 22, 2000
Summary
Symptomatic carotid plaques are more hypoechoic and stenotic than asymptomatic ones. Amaurosis fugax (AF) plaques are more hypoechoic and stenotic than transient ischemic attack (TIA) or stroke plaques, suggesting different mechanisms.
Area of Science:
- Vascular Surgery
- Neurology
- Radiology
Background:
- Carotid bifurcation disease poses a stroke risk influenced by stenosis severity, symptoms, and plaque echodensity.
- Understanding plaque characteristics is crucial for predicting stroke risk.
Purpose of the Study:
- To investigate the relationship between carotid plaque structure (echodensity, stenosis degree) and symptoms in patients with carotid bifurcation disease.
- To determine if asymptomatic plaques differ structurally from symptomatic ones.
Main Methods:
- Duplex scanning of 295 carotid bifurcation plaques in 264 patients (146 symptomatic, 149 asymptomatic) with >50% stenosis.
- Digitization and normalization of B-mode images to objectively measure plaque echodensity using the gray scale median (GSM).
- Classification of symptomatic plaques by associated events: amaurosis fugax (AF), transient ischemic attacks (TIAs), or stroke.
Main Results:
- Symptomatic plaques exhibited higher stenosis (80.5%) and lower echodensity (mean GSM 13.3) compared to asymptomatic plaques (72.2% stenosis, GSM 30.5).
- Plaques associated with AF showed the lowest echodensity (GSM 7.4) and highest stenosis (85.6%).
- Plaques causing TIAs (GSM 14.9, 79.3% stenosis) and stroke (GSM 15.8, 78.1% stenosis) had similar echodensity and stenosis levels.
Conclusions:
- Hypoechoic carotid plaques are more frequently symptomatic and stenotic than hyperechoic ones.
- The distinct characteristics of AF plaques suggest a different underlying pathophysiology compared to TIAs and strokes.
- Plaque echodensity and stenosis degree are significant indicators of cerebrovascular event risk.