Carotid plaque histology using real-time ultrasonography

Reilly, Linda M.; Lusby, Robert J.; Hughes, Linda A.; Ferrell, Linda D.; Stoney, Ronald J.; Ehrenfeld, William K.

doi:10.1016/0002-9610(83)90370-7

Cited by 329 publications

(114 citation statements)

References 17 publications

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“…14 -16 In our study, carotid plaques were classified as complex or simple, depending on their echogenic features and surface morphology. Histological evidence suggests that homogeneous echogenicity is found in collagenrich, fibrous plaques, and heterogeneous echogenicity is found in lipid-rich or hemorrhagic plaques, 14,15 usually associated with an increased number of macrophages. 19 The value of such classification is supported by its prognostic significance, because echolucent (complex) carotid plaques were found to be associated not only with a 3-fold-higher risk of ipsilateral ischemic stroke but also with a 2-fold-higher risk of cardiac ischemic events than echorich (simple) carotid plaques.…”

Section: Discussionmentioning

confidence: 99%

Inflammation as a Possible Link Between Coronary and Carotid Plaque Instability

Lombardo¹,

Biasucci²,

Lanza³

et al. 2004

Circulation

189

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Background-Multiple complex stenoses, plaque fissures, and widespread coronary inflammation are common in acute coronary syndromes. A systemic cause of atherosclerotic plaque instability is also suggested by studies of ischemic cerebrovascular disease. We investigated the association between coronary and carotid plaque instability and the potential common causal role of inflammation. Methods and Results-The ultrasound characteristics of carotid plaques were evaluated retrospectively in patients scheduled for coronary bypass surgery, 181 with unstable and 92 with stable angina, and prospectively in a similar group of patients, 67 with unstable and 25 with stable angina, in whom serum C-reactive protein levels were also measured. The prevalence of carotid plaques was similar in the retrospective and prospective studies and Ͼ64% in both unstable and stable coronary patients.

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Section: Discussionmentioning

confidence: 99%

Inflammation as a Possible Link Between Coronary and Carotid Plaque Instability

Lombardo¹,

Biasucci²,

Lanza³

et al. 2004

Circulation

189

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“…Some of these associations have been disputed, however, with other investigators failing to demonstrate more frequent symptoms associated with ulcerations 14,21 and plaque hemorrhage. 23,24 The documented ability of B-mode ultrasonographic scanning to detect plaque ulceration, 25 heterogeneity, 26,27 and hemorrhage, 28 though disputed by some, 24,29,30 has led to the demonstration that these ultrasound-defined characteristics are also associated with ipsilateral neurologic symptoms, 31 clinical events, 26 and MRI-defined infarcts. 18,32 The mechanisms by which carotid artery disease may be associated with neurological symptoms and stroke include (1) thrombotic occlusion of large vessels such as the carotid and middle cerebral arteries with hypoperfusion in the vascular distribution supplied by these vessels; (2) cerebral embolism of either atheromatous material from a ruptured or ulcerated carotid plaque or of fibrin-platelet material from a thrombotic plaque to distal vessels; or (3) manifestation or general marker of systemic atherosclerosis occurring at the large and small vessel level.…”

Section: Carotid Disease and The Brainmentioning

confidence: 99%

Relationships of Cerebral MRI Findings to Ultrasonographic Carotid Atherosclerosis in Older Adults

Manolio

Burke

O’Leary

et al. 1999

ATVB

182

160

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Abstract-Cerebral magnetic resonance imaging (MRI) has demonstrated a high prevalence of infarct-like lesions, white matter hyperintensities, and evidence of cerebral atrophy in older adults. While these findings are generally believed to be related to ischemia and atherosclerosis, their relationship to atherosclerosis in the carotid arteries remains to be explored. Study subjects were part of the multicenter Cardiovascular Health Study, a cross-sectional study of 3502 women and men Ն65 years of age undergoing cranial MRI and carotid ultrasonography. MRI infarcts were detected in 1068 participants (29.3%) and measurable carotid plaque in 2745 (75.3%). MRI infarcts, ventricular and sulcal widening, and white matter score were strongly associated with carotid intimal-medial thickness (IMT) and stenosis degree after adjustment for age and sex (all PϽ0.01). Associations with plaque characteristics were less strong and less consistent; MRI infarcts were weakly associated only with surface irregularity, and ventricular size was weakly associated only with lesion density (both PϽ0.04). In contrast, sulcal widening was strongly related to plaque characteristics, with scores being higher in those with heterogeneous and irregular plaque (both PϽ0.009 Key Words: stroke Ⅲ cerebrovascular disorders Ⅲ carotid arteries Ⅲ atherosclerosis Ⅲ aged Ⅲ epidemiology Ⅲ risk factors C erebral magnetic resonance imaging (MRI) has demonstrated a high prevalence of infarct-like lesions, white matter hyperintensities, and evidence of cerebral atrophy in older adults. 1-3 While these findings are related to standard risk factors for cardiovascular disease and are believed to be consequences of ischemia, 4 -6 their relationship to atherosclerosis in the carotid arteries has not been widely explored.Because the carotid arteries provide the majority of the brain's blood supply, detailed information on extent, severity, and characteristics of carotid atherosclerosis can be used to explore its relationships to cerebral MRI findings. Lesion characteristics such as increased density, heterogeneity, and surface irregularity have been shown to relate to prevalent clinically defined transient ischemic attack and stroke, 6 but these associations have not been examined for cerebral MRI findings.The Cardiovascular Health Study (CHS) cohort represents a large, multicenter sample of older men and women examined by both carotid ultrasonography and cerebral MRI. Cross-sectional data from these examinations were analyzed (1) to describe prevalences of MRI-defined infarcts, infarctlike lesions, and gray and white matter changes by quintile of common and internal carotid intimal-medial thickness (IMT); degree of carotid stenosis; and characteristics of carotid plaque; (2) to determine independence of carotid atherosclerosis/MRI abnormality associations from known clinical and subclinical cardiovascular disease and cardiovascular disease risk factors; and (3) to define relationships of MRI infarcts and ipsilateral carotid artery disease. MethodsCHS participants ...

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“…Other less well-substantiated risk factors that might worsen the natural history of asymptomatic stenosis include the presence of an occluded contralateral carotid artery, 39 progressive stenosis, 40 a "soft" or echolucent plaque or evidence of intraplaque hemorrhage on ultrasound. [40][41][42][43] Another logical proposal is that greater benefit will accrue for younger patients (≤55 years) undergoing surgery for asymptomatic stenosis. 44 The situation for moderate, 50%-69% symptomatic stenosis is similar to asymptomatic stenosis.…”

Section: Discussionmentioning

confidence: 99%

Auditing Carotid Endarterectomy: A Regional Experience

Findlay

Nykolyn²,

Lubkey³

et al. 2002

Can. j. neurol. sci.

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326Studies and commentaries from the 1980s expressing concern about the efficacy, appropriateness, and complications of carotid endarterectomy (CEA), 1 -8 were followed by a series of multicenter randomized controlled trials comparing CEA to medical treatment alone. Reported throughout the 1990s, these studies validated the use of CEAunder certain circumstances, [9][10][11][12][13][14][15] and led to a rapid and large resurgence in the use of CEA in A B S T R A C T: Background: Proof from randomized controlled trials that carotid endarterectomy (CEA) is efficacious in stroke prevention has resulted in a large resurgence of its use in recent years. We wished to determine if patients in our region were being selected and treated with complication rates consistent with the randomized trials. Methods: We have completed four audits of CEAs performed in our region since 1994, each followed by feed-back of results to the participating surgeons. Operations for > 70% symptomatic stenosis were considered appropriate, those for 50%-69% symptomatic and > 60% asymptomatic stenosis were considered uncertain and all others, including those in medically or neurologically unstable patients, were designated inappropriate. In part 4, the referral source and nature of the patients was also determined. Results: Part 1 (April 1994 -September 1995 found that of 291 CEAs performed 33% were appropriate, 48% were uncertain and 18% were inappropriate, and 40% of patients who underwent CEA were asymptomatic. In part 2 (September 1996 -September 1997) appropriate indications significantly improved to 49% of 184 CEAs (P=0.005), uncertain indications remained nearly the same at 47%, inappropriate indications fell to 4% (P=0.00002), and asymptomatic patients remained at 40%. T h e results of part 3 (October 1997 -October 1998) remained nearly the same as part 2 (249 CEAs, 47% appropriate, 51% uncertain, 2% inappropriate, 45% asymptomatic). Part 4 (October 1999 -October 2000) results were significantly better than part 3, appropriate indications increasing from 47% to 58% of 222 CEAs (P=0.02), and an elimination of inappropriate operations (P=0.03). Stroke and death complications declined over the study period from an overall rate of 5.2% in part 1 to 2.3% in part 4. In part 4 the majority of patients (69%) were referred to surgeons directly from general practitioners, including 58 (73%) of the 80 asymptomatic patients who underwent CEA. Interpretation: Regular auditing and feedback of results and information to surgeons has resulted in significant and continued improvements in the surgical performance of CEAin our region. Since the majority of patients are referred directly to surgeons by general practitioners, it is important that this group of physicians be familiar with current CEA g u i d e l i n e s . RÉSUMÉ: Évaluation de l'endartérectomie carotidienne: une expérience régionale. Introduction: La preuve basée sur des études contrôlées randomisées que l'endartérectomie carotidienne (EAC) est efficace dans la prévention de l'accident vascul...

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Carotid plaque histology using real-time ultrasonography

Cited by 329 publications

References 17 publications

Inflammation as a Possible Link Between Coronary and Carotid Plaque Instability

Inflammation as a Possible Link Between Coronary and Carotid Plaque Instability

Relationships of Cerebral MRI Findings to Ultrasonographic Carotid Atherosclerosis in Older Adults

Auditing Carotid Endarterectomy: A Regional Experience

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