Association of plaque echostructure and cardiovascular risk factors with symptomatic carotid artery disease
A D Giannoukas1, G S Sfyroeras, M Griffin
1Imperial College School of Medicine, London, U.K. agiannoukas@hotmail.com
Insights
Echolucent carotid plaques are linked to symptomatic internal carotid artery (ICA) disease, independent of stenosis severity. Younger patients with echolucent plaques suggest an age-related association with plaque maturation.
Area of Science:
- Vascular Medicine
- Neurology
- Cardiology
Background:
- Internal carotid artery (ICA) stenosis severity is a primary stroke risk factor.
- Investigating plaque echostructure and cardiovascular risk factors for symptomatic ICA disease is crucial.
Purpose of the Study:
- To determine the association between carotid plaque echostructure and cardiovascular risk factors with symptomatic internal carotid artery (ICA) disease.
- To identify predictors of stroke risk beyond stenosis severity.
Main Methods:
- Cross-sectional study of 124 patients with significant (>50%) ICA stenosis.
- Assessed carotid plaque echostructure, traditional and emerging cardiovascular risk factors.
- Compared asymptomatic (n=70) and symptomatic (n=54) patient groups.
Main Results:
- Echolucent plaques (types 1 and 2) were significantly more prevalent in symptomatic patients (p=0.004, OR=2.13).
- No significant association was found between other assessed factors and symptomatic disease or plaque type.
- Younger patients were more likely to have echolucent plaques (type 1 vs. type 4, p=0.02).
Conclusions:
- Echolucent plaque is an important factor associated with symptomatic ICA disease, in addition to stenosis severity.
- Plaque echolucency may indicate an age-related association with plaque maturation, with younger patients exhibiting more echolucent plaques.
Background:
Severity of stenosis remains the main factor for assessing risk of stroke in patients with internal carotid artery (ICA) disease. This study was conducted to investigate the association of plaque echostructure and other established and emerging cardiovascular risk factors with symptomatic ICA disease.
Design:
Cross-sectional study of consecutive patients with significant (> 50%) ICA stenosis.
Patients And Methods:
Carotid plaque echostructure, smoking, hypertension, diabetes mellitus, serum lipoprotein (a), homocysteine, vitamin B12, folate, cholesterol to high-density lipoprotein ratio, triglycerides, C-reactive protein, and the Framingham risk score were assessed in 124 consecutive patients (70 asymptomatic; 54 symptomatic) with significant (> 50%) ICA stenosis.
Results:
The asymptomatic and symptomatic groups did not differ in terms of gender distribution (p = 0.76) and severity of stenosis (p = 0.62). Echolucent plaques (type 1 and 2) were more predominant in patients with symptomatic disease (p = 0.004, OR = 2.13, 95% CI = 1.26-3.6). Patients with plaques type 1 were relatively younger than those with type 4 (p = 0.02). None of the other factors assessed had any significant association with symptomatic disease and any type of carotid plaque.
Conclusions:
Besides the severity of carotid stenosis, the presence of an echolucent plaque appears as an important factor associated with symptomatic ICA disease. Also, young patients are more likely to have an echolucent plaque suggesting an age-related association with plaque maturation.
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