Ultrasonic echolucent carotid plaques predict future strokes.

Area of Science:

• Neurology
• Vascular Medicine
• Medical Imaging

Background:

• Carotid artery stenosis is a significant risk factor for ischemic stroke.
• Predicting stroke risk in patients with carotid atherosclerosis remains a clinical challenge.
• Plaque characteristics, such as echolucency, may offer prognostic value.

Purpose of the Study:

• To prospectively evaluate if carotid plaque echolucency predicts stroke development.
• To assess this prediction in both previously symptomatic and asymptomatic patients.
• To determine if echolucency improves stroke risk stratification beyond stenosis degree.

Main Methods:

• Prospective study of 246 patients (111 asymptomatic, 135 symptomatic) with >=50% carotid artery stenosis.
• High-resolution B-mode ultrasound with computer-assisted image processing assessed plaque echogenicity.
• Doppler ultrasound evaluated the degree of carotid artery stenosis.
• Follow-up for ipsilateral ischemic strokes over 4.4 years.

Main Results:

• 44 ipsilateral ischemic strokes were observed during follow-up.
• In symptomatic patients, echolucent plaques significantly increased stroke risk (Relative Risk = 3.1).
• Higher stenosis (80-99%) showed a trend towards increased risk (RR=1.4) in symptomatic patients, but echolucency was a stronger predictor.
• No significant association between plaque echolucency and stroke risk was found in asymptomatic patients.

Conclusions:

• Echolucent carotid plaques are associated with future stroke risk in symptomatic individuals with significant stenosis.
• Plaque echolucency, in addition to stenosis severity, may enhance patient selection for carotid endarterectomy.
• This imaging marker does not appear to predict stroke risk in asymptomatic patients with carotid stenosis.