Association of plaque echostructure and cardiovascular risk factors with symptomatic carotid artery disease
A D Giannoukas1, G S Sfyroeras, M Griffin
1Department of Vascular Surgery, University Hospital of Larissa, University of Thessaly Medical School, Larissa, Greece. agiannoukas@med.uth.gr
Insights
Echolucent carotid plaques, not traditional risk factors, are linked to symptomatic internal carotid artery (ICA) disease. Younger patients with ICA stenosis are more prone to developing these echolucent plaques.
Area of Science:
- Vascular Neurology
- Cardiovascular Research
- Medical Imaging
Background:
- Internal carotid artery (ICA) stenosis severity is a primary stroke risk determinant.
- Understanding factors beyond stenosis severity is crucial for assessing stroke risk in ICA disease.
Purpose of the Study:
- To investigate the association between carotid plaque echostructure and cardiovascular risk factors with symptomatic ICA disease.
- To identify predictors of symptomatic versus asymptomatic internal carotid artery stenosis.
Main Methods:
- A cross-sectional study included 124 patients with >50% ICA stenosis.
- Carotid plaque echostructure and various cardiovascular risk factors were assessed.
- Patients were categorized into symptomatic (54) and asymptomatic (70) groups.
Main Results:
- Echolucent plaques (types 1 and 2) were significantly more common in symptomatic patients (OR=2.13).
- No significant association was found between other assessed risk factors and symptomatic disease or plaque type.
- Younger patients were more likely to have echolucent plaques (type 1) compared to type 4.
Conclusions:
- Echolucent plaque presence is a significant factor associated with symptomatic ICA disease, independent of stenosis severity.
- Plaque echolucency may indicate an age-related association with plaque maturation.
- Further research into plaque characteristics could refine stroke risk prediction in ICA disease.
Aim:
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.
Methods:
Cross-sectional study of consecutive patients with significant (>50%) ICA stenosis. 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.
Conclusion:
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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