Atherosclerotic plaque surface morphology in the carotid bifurcation assessed with multidetector computed tomography
Thomas T de Weert1, Sander Cretier, Harald C Groen
1Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Insights
Complicated carotid plaques, often irregular or ulcerated, are common in atherosclerotic disease, particularly with higher stenosis. These plaques are linked to hypercholesterolemia and smoking, increasing stroke risk.
Area of Science:
- Vascular imaging and neurology
- Cerebrovascular disease research
- Atherosclerosis characterization
Background:
- Complicated carotid plaques (irregular or ulcerated) are independent predictors of stroke.
- Understanding plaque morphology is crucial for assessing stroke risk in ischemic cerebrovascular disease.
Purpose of the Study:
- To analyze the frequency and location of carotid plaque irregularities.
- To correlate plaque morphology with stenosis severity, cardiovascular risk factors, and symptoms.
Main Methods:
- Multidetector CT angiography used to evaluate 406 patients.
- Carotid plaque surface classified as smooth, irregular, or ulcerated.
- Ulceration location assessed relative to maximum stenosis.
Main Results:
- Complicated plaques (irregular/ulcerated) found in 38% of atherosclerotic carotid arteries.
- Ulcerations predominantly located proximal to maximum stenosis (69%).
- Complicated plaques significantly associated with stenosis >30%, hypercholesterolemia (OR 3.0), and a trend with smoking (OR 1.9).
Conclusions:
- Multidetector CT angiography effectively classifies atherosclerotic carotid plaque surface.
- Complicated plaques are frequent in carotid atherosclerosis, especially with high-grade stenosis.
- Hypercholesterolemia and smoking are associated with complicated plaque formation.
Background And Purpose:
Complicated (irregular or ulcerated) carotid plaques have proven to be independent predictors of stroke. We analyzed the frequency and location of plaque irregularities in a large cohort of patients with ischemic cerebrovascular disease and the relation with severity of stenosis, cardiovascular risk factors, and symptomatology.
Methods:
Multidetector CT angiography images from 406 patients were evaluated. Plaque surface morphology was classified as smooth, irregular, or ulcerated. The location of the ulceration was defined as proximal or distal to the point of maximum stenosis.
Results:
Atherosclerotic plaques with an open lumen were present in 448 carotid arteries; these plaques were classified as: smooth, 276 (62%); irregular, 99 (22%); and ulcerated, 73 (16%). Sixty-two (69%) of the ulcerations were located proximal to the point of maximum luminal stenosis. Complicated plaques were significantly (P<0.001) more common in carotid arteries with stenosis >30% than in those with stenosis <30%. There is an association between complicated plaques and hypercholesterolemia (OR, 3.0) and a trend toward an association with smoking (OR, 1.9). Complicated plaques are more often present in the symptomatic carotid artery than in the contralateral asymptomatic carotid artery; however, this is fully attributed to a significantly higher degree of stenosis in the symptomatic arteries.
Conclusions:
Multidetector CT angiography allows the classification of atherosclerotic carotid plaque surface. Complicated plaques are frequent in atherosclerotic carotid disease, especially with higher stenosis degree. Ulcerations are mostly located in the proximal part of the atherosclerotic plaque. Hypercholesterolemia and smoking are related with the presence of complicated plaques.
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