Spontaneous progression and regression of small carotid atheroma

A specially designed high-resolution (10 MHz) ultrasound duplex-system was used to study prospectively the appearance of 43 extracranial non-stenotic carotid plaques (less than 30% lumen narrowing) in 31 patients over 18 months. 13 presented with ipsilateral and 9 with contralateral cerebrovascular events; 9 were asymptomatic. Most carotid atheromas remained unchanged (51%) or progressed (30%), but spontaneous regression was seen in 19% at regular 3 monthly re-examination. Regression was restricted to volume reduction of soft plaques and healing of ulcerative lesions; fibrous and hard plaques remained unchanged or progressed. Intraplaque haemorrhage was only observed in 3 instances and was always associated with later progressive encroachment. Comparison of bilateral plaques in the same individual suggested a uniform advance with duration of the atherosclerotic process. None of the patients had cerebrovascular events during follow-up.