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[Ultrasonography of the progression of atherosclerotic plaques]
1Sección de Neurología, Hospital Universitari Doctor Josep Trueta, Girona, España. jserenal@meditex.es
Insights
Ultrasound plaque analysis can identify stroke risk in carotid stenosis patients, regardless of stenosis degree. This improves risk stratification beyond traditional measures for better patient outcomes.
Area of Science:
- Neurology
- Vascular Surgery
- Medical Imaging
Background:
- Severe carotid stenosis is a primary cause of ischemic stroke.
- Carotid endarterectomy is recommended for >80% stenosis per ECST study.
- Current guidelines may not adequately identify stroke risk in moderate stenosis.
Purpose of the Study:
- To review ultrasound characteristics of atheromatous plaques.
- To correlate plaque features with stroke risk.
- To discuss plaque progression and classification.
Main Methods:
- Utilizing color duplex ultrasound to assess carotid stenosis.
- Analyzing flow curve characteristics and plaque structure.
- Correlating ultrasound findings with anatomopathological data.
Main Results:
- Ultrasound can differentiate stroke risk independently of stenosis degree.
- Specific plaque characteristics are associated with increased stroke risk.
- Ultrasound precision matches anatomopathological findings.
Conclusions:
- Ultrasound assessment of plaque structure is crucial for stroke risk stratification.
- Understanding plaque characteristics aids in identifying high-risk patients.
- This approach refines patient selection for interventions.
Introduction:
Severe carotid stenosis is the single most important aetiological factor in focal cerebral ischaemia. Carotid endarterectomy is indicated in stenosis of greater than 80% according to the results of the study ECST.
Development:
Since the morbimortality associated with carotid endarterectomy in patients with moderate stenosis is similar to the incidence of stroke in patients treated with drugs, different criteria should be used to quantify stenosis for the detection of patients with a high risk of having a stroke. Ultrasound study (colour duplex) permits one to not only determine the degree of carotid stenosis, based on the characteristics of the flow curve, but also to analyse the structure of the atheromatous plaque. That is to say that one can distinguish between patients with a high risk of stroke and those with a low risk, independently of the degree of carotid stenosis. The ultrasound study has not only shown great precision in identification of the different components of the plaque of atheroma described in anatomopathological studies, but has also made apparent the association between certain characteristics of the atheromatous plaque, the risk of its progression and the risk of stroke.
Conclusions:
In this review we consider the ultrasound characteristics of the atheromatous plaque and the risk of stroke associated with it; the different ultrasound patterns and their correlation with anatomopathological findings; we review the mechanisms of progression of atheromatous plaques and finally describe their classification according to the recommendations of the second International Consensus.