Carotid Plaque Morphology Is Significantly Associated With Sex, Age, and History of Neurological Symptoms

Abstract

T he short-term risk of stroke or death of surgically treated patients having a symptomatic carotid stenosis has been shown to be similar in younger and older patients (<70 years [5.7%] versus ≥70 years [5.9%]).1 In contrast, a meta-analysis of 3 large randomized controlled trials (EVA-3S, SPACE, ICSS) revealed that the risk of stroke or death after carotid artery stenting increases significantly with age (<70 years [5.8%] versus ≥70 years [12.0%]).1 A similar trend (although not significant) has also been found in asymptomatic patients, particularly when sex was taken into account. 2 These observations might be explained by embolism derived from ruptured plaques or sheared-off arterial calcifications caused by guidewire manipulations during carotid artery stenting procedures. 3,4 In addition, multivariable analyses of pooled randomized controlled trial data on symptomatic patients showed that men have had a higher risk of stroke or death when treated with carotid artery stenting compared with carotid endarterectomy (9.0% versus 5.5%, respectively).1 In contrast, no significant differences were found in women. 1 This discrepancy in the available data raises the question of whether age and sex are associated with differences in plaque morphology or plaque composition.The pathophysiological development of an atherosclerotic plaque is a long-lasting and dynamic process. 5 The development of atherosclerosis begins already at an early age. However, the incidence of clinically apparent atherosclerosisrelated cardiovascular events increases only at an advanced age. [6][7][8][9][10] In Germany, the prevalence of extracranial carotid artery stenosis (>50%) is ≈6.9% in patients aged >65 years but increases further with age. 4,11 Among all ischemic stroke events, ≈15% were caused by arterioarterial embolization from extracranial atherosclerotic carotid artery stenosis. 4 InBackground and Purpose-The purpose of this study was to analyze the association between morphological characteristics of human carotid plaques and patient's sex, age, and history of neurological symptoms. Methods-The study included 763 atherosclerotic plaques from patients treated surgically for carotid stenosis between 2004 and 2013. Histological analyses of carotid plaques were performed to assess the type of plaque (American Heart Association classification), the stability of the plaque, the extent of calcification, inflammation, and neovascularization, as well as the deposition of collagen and elastin. According to the scale of outcome measurement, logistic regression, ordinal regression, and multinomial regression analyses were applied. All results were adjusted for common risk factors of atherosclerosis. contrast, in coronary arteries, acute angina underlies the consequences of rupture or erosion of the plaque surface and subsequent luminal thrombus formation. 12,13 It is also known from coronary artery disease that fibrous plaques are mainly associated with stable syndromes, whereas atheromatous plaques are more often related to unstable ...

Impact of sex and age on carotid plaque instability in asymptomatic patients-results from the Munich Vascular Biobank

“…Consequently, our results show an association rather than implied causality. Also, similar to our previous study [20], we calculated odds ratios, which tend to overestimate the underlying eff ects. In addition, the estimation of plaque instability was determined according to Redgrave and Rothwell in 2008 [23], which might lead to subjective results.…”

“…These authors analyzed 264 asymptomatic patients, focusing not directly on age or sex, but on patients with ipsilateral clinical events more than 6 months before CEA. In our recently published work [20], we analyzed patients with high-grade carotid artery stenosis using a complex multinomial regression model. Our results revealed that male sex was signifi cantly associated with infl ammation and neovascularization.…”

“…Criteria to include carotid specimens in the current study were suffi cient quality of plaque tissue for reliable histological and morphological characterization, the availability of corresponding patient history and clinical data, as described previously [20]. The indication of patients for surgical intervention was based upon the recommendation of the German Society of Vascular Surgery according to the Asymptomatic Carotid Atherosclerosis Study and the North American Symptomatic Carotid Endarterectomy Trial [9,21].…”

“…Histological characterization of atherosclerotic plaques was performed following the hematoxylin-eosin and elastic van Gieson staining procedures to assess the pathomorphological features of all segments, as described previously [5,20,22]. Lesion stability was defi ned as described by Redgrave et al [23], considering a thin fi brous cap of less than 200 μm over a large lipid-rich atheroma as a cut-off to distinguish between stable and unstable atherosclerotic plaques ( Figure 1).…”

„Only size (diameter) does matter“ – Stellen wir bei der asymptomatischen Karotis-interna-Stenose die richtigen Fragen?

“…Eckstein wurde herausgearbeitet, dass der Nachweis einer Plaque-Hämorrhagie oder einer dünnen fibrösen Kappe (unter Berücksichtigung von Alter und Geschlecht) geeignet sein kann, Patienten mit einem erhöhten Schlaganfallrisiko zu identifizieren [15].…”