[Carotid artery atherosclerotic stenosis, plaque structure and stroke]

The main indication for carotid endarterectomy is severity of stenosis carotid artery. Several studies have shown the relationship between carotid plaque morphology and cerebrovascular disorders. The purpose of this study was to evaluate the structure of carotid plaque and correlate carotid plague morphology with neurological symptoms, stroke risk factors, severity of carotid stenosis and operative stroke.

Operative specimens of 262 carotid plaques were examined macroscopically. Plague morphology was characterized as either heterogeneous or homogeneous. Stroke risk factors, cerebrovascular symptoms, severity of carotid stenosis and risk for mortality and operative stroke were compared between symptomatic and asymptomatic patients with heterogeneous and homogeneous plague.

Heterogeneous plaques were present in 198 (75%) of 262 arteries. Heterogeneous plaques were found in 121 symptomatic and 77 asymptomatic patients (p<0.001). Homogeneous plagues did not differ in symptomatic and asymptomatic patients. The structure of plaque did not correlate with any severity of stenosis. There were no significant differences in age, sex, smoking and arterial hypertension between heterogeneous and homogeneous groups. Higher level of fibrinogen but not hypercholesterolemia was associated with heterogeneity of plaque. Postoperative stroke was mainly present in the patients with heterogeneous plaques, but the difference was not statistically significant.

Heterogeneous plaques were present in 75 % of patients with carotid artery stenosis. Heterogeneous plagues were associated with cerebrovascular symptoms more often than homogeneous ones. Plague structure did not correlate with severity of carotid artery stenosis and operative stroke was not associated with plaque heterogeneity. These findings suggest that plague heterogeneity should be considered in selecting patients for carotid endarterectomy.