Composition of the Stable Carotid Plaque

Nandalur, Kiran R.; Hardie, Andrew D.; Raghavan, Prashant; Schipper, Matthew J.; Baskurt, Erol; Kramer, Christopher M.

doi:10.1161/01.str.0000257995.74834.92

Cited by 123 publications

(48 citation statements)

References 37 publications

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“…Previous studies33, 41, 42 measuring CPV by both MRI and CT suggested that CPV was associated with cardiovascular risk factors and symptoms of cerebral ischaemia. If the accuracy of tUS measurement of CPV is confirmed in larger studies, it is possible that the measurement of CPV could replace severity of stenosis as the principal indication for CEA.…”

Section: Discussionmentioning

confidence: 96%

Carotid plaque volume in patients undergoing carotid endarterectomy

Ball

Rogers

Kanesalingam

et al. 2018

British Journal of Surgery

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BackgroundThe main indication for carotid endarterectomy (CEA) is severity of carotid artery stenosis, even though most strokes in carotid disease are embolic. The relationship between carotid plaque volume (CPV) and symptoms of cerebral ischaemia, and the measurement of CPV by minimally invasive tomographic ultrasound imaging, were investigated.MethodsThe volume of the endarterectomy specimen was measured using a validated saline suspension technique in patients undergoing CEA. Time from last symptom and severity of stenosis measured by duplex ultrasonography were recorded. Middle cerebral artery emboli were counted using transcranial Doppler imaging (TCD) in a subset of patients.ResultsSome 339 patients were included, 270 with symptomatic and 69 with asymptomatic carotid stenosis. Mean(s.d.) CPV was higher in symptomatic than in asymptomatic patients (0·97(0·43) versus 0.74(0·41) cm3; P < 0·001). CPV did not correlate with severity of carotid stenosis (P = 0·770). Mean CPV was highest at 1·03(0·46) cm3 in the 4 weeks following cerebral symptoms, declining to 0·78(0·36) cm3 beyond 8 weeks. Among 33 patients who had TCD, mean CPV was 1·00(0·48) cm3 in the 27 patients with ipsilateral cerebral emboli compared with 0·67(0·16) cm3 in those without (P = 0·142). There was excellent correlation between CPV measured by tomographic ultrasound imaging and the endarterectomy specimen in 34 patients (r = 0·93, P < 0·001).ConclusionCPV correlated with symptoms of cerebral ischaemia, but not carotid stenosis. It could be a potential indicator for CEA.

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Section: Discussionmentioning

confidence: 96%

Carotid plaque volume in patients undergoing carotid endarterectomy

Ball

Rogers

Kanesalingam

et al. 2018

British Journal of Surgery

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“…13,[26][27][28][29][30] In a recent study on MDCT, the relationship between stroke symptoms and plaque morphology was assessed. 30 In the study, expansive carotid remodeling was greater in patients with cerebral ischemic symptoms than in asymptomatic patients, though there was no significant difference in the plaque eccentricity between symptomatic and asymptomatic patients.…”

Section: Discussionmentioning

confidence: 99%

Eccentric Stenosis of the Carotid Artery Associated with Ipsilateral Cerebrovascular Events

Ohara

Toyoda²,

Otsubo³

et al. 2008

AJNR Am J Neuroradiol

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“…14 The CTA modality with modern, multislice scanners is excellent for localization and quantification of calcification, 21 and the relationship to internal architecture, ulceration, and prediction of "vulnerability" is becoming clear. 13,29,30 Although the CT calcification grade is known to predict the expansion of coronary stents 15 and has been suggested to be a relative contraindication to CAS, 8,16 few investigators use plaque morphology to help guide the choice of treatment 19 or to predict the immediate or long-term morphological success of CAS procedures.…”

Section: Discussionmentioning

confidence: 99%

Plaque morphology (the PLAC Scale) on CT angiography: predicting long-term anatomical success of primary carotid stenting

Pelz¹,

Lownie²,

Lee³

et al. 2015

JNS

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C arotid angioplasty and stenting (CAS) has evolved into an alternative to carotid endarterectomy (CEA) for the treatment of atherosclerotic carotid stenosis, particularly since the publication of the Carotid Revascularization Endarterectomy versus Stent Trial (CREST) in 2010. 4 In the CREST, as in most other randomized controlled trials and large case series, the standard technical protocols include the use of embolic protection devices (EPDs), self-expanding stents (SESs), and balloons preand postdilation. It has, however, been shown that EPDs do not catch all debris generated by balloons and that these expensive devices may cause complications themselves. 10Every pass of a device through an atherosclerotic stenosis generates distal emboli.2,31 Balloon angioplasty, both before and after stent insertion, releases significant amounts of embolic debris 20,24,26,28,33 and often results in significant hemodynamic instability, defined as bradycardia (< 60 beats/min) and hypotension (systolic blood pressure < 90 mm Hg).27 Some major centers now rarely perform prestent balloon angioplasty, deliberately undersize poststent abbreviatioNs CAS = carotid angioplasty and stenting; CEA = carotid endarterectomy; CREST = Carotid Revascularization Endarterectomy versus Stent Trial; CTA = CT angiography; EPD = embolic protection device; NASCET = North American Symptomatic Carotid Endarterectomy Trial; PCS = primary carotid stenting; PLAC = Predicting Long-term outcome with Angioplasty of the Carotid artery; PSV = peak systolic velocity; SES = self-expanding stent. obJect Carotid angioplasty and stenting has emerged as an alternative to carotid endarterectomy for the treatment of atherosclerotic carotid stenosis. Primary carotid stenting, performed using self-expanding stents alone without deliberate use of embolic protection devices and balloon angioplasty, has been shown to be effective and faster, cheaper, and potentially safer than conventional techniques. However, the long-term morphological results of this technique have not been established. The aim of this study was to determine whether preprocedural carotid plaque imaging at the site of maximal stenosis by using CT angiography (CTA) could predict the long-term morphological outcome of primary carotid stenting. methods One hundred eighty-one patients were treated over an 11-year period. Preprocedural CTA was performed in 102 of these. A morphological scale (the Predicting Long-term outcome with Angioplasty of the Carotid artery [PLAC] Scale), with grades from 0 to 4 and A or B, was used to evaluate the circumferential degree of plaque calcification, and the presence or absence of soft plaque. All patients were followed using duplex carotid ultrasound and plain radiographs. Satisfactory morphological outcome was defined as a peak systolic velocity < 120 cm/s and internal carotid artery/common carotid artery ratio < 1.4. results The average follow-up duration was 29.7 months (median 24.5 months, range 0.3-87 months). Univariate logistic regression demonstrated that a low ca...

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Composition of the Stable Carotid Plaque

Cited by 123 publications

References 37 publications

Carotid plaque volume in patients undergoing carotid endarterectomy

Carotid plaque volume in patients undergoing carotid endarterectomy

Eccentric Stenosis of the Carotid Artery Associated with Ipsilateral Cerebrovascular Events

Plaque morphology (the PLAC Scale) on CT angiography: predicting long-term anatomical success of primary carotid stenting

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