Changes in carotid plaque echomorphology with time since a neurologic event

Area of Science:

• Vascular biology and neurology
• Medical imaging and diagnostics
• Cardiovascular disease research

Background:

• Symptomatic carotid plaques exhibit characteristics like reduced fibrous tissue, increased lipid content, intraplaque hemorrhage, and cap rupture, all associated with elevated stroke risk.
• Plaque remodeling can mitigate stroke risk, necessitating an understanding of echomorphological changes over time post-neurologic events.

Purpose of the Study:

• To evaluate differences in carotid plaque echomorphology at varying time intervals following a neurologic event.
• To assess how plaque echolucency and heterogeneity change dynamically after symptom onset.

Main Methods:

• B-mode ultrasound imaging was used to analyze 61 symptomatic carotid plaques (70%-99% stenosis) categorized by time since neurologic event (<=30, 31-90, 91-180, >180 days).
• Gray Scale Median (GSM) was measured using single longitudinal view (SLV) and multiple cross-sectional views (MCSV) to determine plaque echolucency and heterogeneity.
• Results were compared against 47 asymptomatic plaques.

Main Results:

• Echolucency in symptomatic plaques peaked within 30 days of the neurologic event (SLV-GSM, P = .009; MCSV(min)-GSM, P = .004).
• Plaque echolucency decreased between 31 to 90 days, but MCSV measurements indicated sustained echolucency (P = .042 at >180 days) and ongoing heterogeneity (P = .01 at 91-180 days).

Conclusions:

• Carotid plaque echolucency is maximal within 30 days of a neurologic event and diminishes thereafter, suggesting plaque remodeling.
• Persistent increased echolucency and heterogeneity beyond 91 days post-event indicate a potentially elevated stroke risk compared to the general population.