Natural history of asymptomatic carotid plaque. Five year follow-up study

Area of Science:

• Vascular Surgery
• Neurology
• Diagnostic Imaging

Background:

• Carotid bifurcation disease is a significant risk factor for stroke.
• Accurate risk stratification is crucial for guiding treatment decisions, such as carotid endarterectomy.
• Ultrasonography is a key imaging modality for assessing carotid artery disease.

Purpose of the Study:

• To evaluate the combined impact of carotid artery stenosis degree and plaque morphology on the risk of transient ischemic attack (TIA) or stroke.
• To determine if plaque characteristics can refine risk prediction in patients with carotid bifurcation disease.

Main Methods:

• Prospective analysis of 296 carotid arteries in 293 asymptomatic patients with carotid bifurcation disease.
• Real-time B-mode ultrasonography was used to assess degree of stenosis (≥75% vs. <75%) and plaque morphology (calcified, dense, soft).
• Patients were followed for an average of 46 months, with TIA or stroke as the primary endpoint.

Main Results:

• Patients with hemodynamically significant stenosis (≥75%) had a higher risk of TIA or stroke compared to those with <75% stenosis.
• Even with <75% stenosis, patients with less organized (dense or soft) plaques were at increased risk.
• The highest risk was observed in patients with significant stenosis and soft plaque.
• The lowest risk was associated with calcified plaque and <75% stenosis.

Conclusions:

• Both the degree of carotid artery stenosis and plaque morphology are critical factors in predicting stroke risk.
• Morphological plaque characteristics, particularly soft or dense plaques, provide additional prognostic information beyond stenosis severity.
• These findings can help identify asymptomatic patients who would benefit most from carotid endarterectomy.