Related Experiment Videos
Incidence of bilateral intraplaque hemorrhage in carotid artery disease
1Department of Surgery, University of Kansas School of Medicine, Wichita.
Insights
Intraplaque hemorrhage in one carotid artery strongly predicts its presence in the other. This finding in patients undergoing carotid endarterectomy suggests a need for vigilant monitoring of these individuals.
Area of Science:
- Vascular Surgery
- Neurology
- Pathology
Background:
- Stroke is a leading cause of death and disability in the US.
- Carotid occlusive disease contributes significantly to cerebrovascular accidents.
- Carotid artery intraplaque hemorrhage is a key factor in ischemic stroke pathogenesis.
Purpose of the Study:
- To investigate if unilateral intraplaque hemorrhage predicts contralateral intraplaque hemorrhage.
- To assess the significance of intraplaque hemorrhage in patients undergoing bilateral carotid endarterectomy.
Main Methods:
- Retrospective review of 47 patients who underwent staged bilateral carotid endarterectomy.
- Pathological examination of carotid plaques for the presence of intraplaque hemorrhage.
- Analysis of the correlation between hemorrhage in the initially operated side and the contralateral side.
Main Results:
- 33 out of 47 patients (70%) showed intraplaque hemorrhage on the initial side.
- 82% (27 of 33) of these patients also had intraplaque hemorrhage on the contralateral side.
- A high predictive value (82%) was found for contralateral intraplaque hemorrhage.
Conclusions:
- Intraplaque hemorrhage in one carotid artery is a strong predictor of hemorrhage in the contralateral artery.
- Patients with unilateral intraplaque hemorrhage may require more aggressive follow-up.
- This finding has implications for stroke risk stratification and management.
Abstract:
Stroke is an important source of morbidity and mortality in the USA. Carotid occlusive disease is associated with most cerebrovascular accidents, and carotid artery intraplaque hemorrhage is particularly important in the pathogenesis of cerebral ischemic symptoms. The authors' experience with intraplaque hemorrhage in patients undergoing bilateral carotid endarterectomy was reviewed to determine whether unilateral intraplaque hemorrhage is predictive of the condition occurring on the contralateral side. Forty-seven patients underwent staged bilateral carotid endarterectomy performed by one vascular surgeon. Each plaque was reviewed by a pathologist for the presence of intraplaque hemorrhage. Of these patients, 33 demonstrated intraplaque hemorrhage on the side of initial endarterectomy; 27 of these 33 (82%) had bilateral hemorrhage. It was concluded that intraplaque hemorrhage in the initially operated carotid atheroma is highly predictive of the condition occurring in the contralateral atheroma. Furthermore, aggressive follow-up in this patient population may be warranted.