Correlative Angiographic and Pathologic Findings in the Diagnosis of Ulcerated Plaques in the Carotid Artery

Estol, Conrado J.; Claassen, Diana; Hirsch, William L.; Wechsler, Lawrence R.; Moossy, John

doi:10.1001/archneur.1991.00530190038012

Cited by 20 publications

(10 citation statements)

References 23 publications

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“…3 " 8 The sensitivity of detecting plaque ulceration ranged from 53% to 86% as reported in these studies. Further comparisons among these studies are complicated by the comparative standard that was used to verify the presence of plaque ulceration and by the variable definitions that were used for the angiographic diagnosis of ulceration.…”

Section: Discussionmentioning

confidence: 69%

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Angiographic detection of carotid plaque ulceration. Comparison with surgical observations in a multicenter study. North American Symptomatic Carotid Endarterectomy Trial.

Streifler

Eliasziw

Fox

et al. 1994

Stroke

144

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Carotid plaque ulceration is used as one of the determinants in deciding which patients should be submitted to carotid endarterectomy. Uncertainties about its importance persist. Its detection by angiography is an important consideration. The detection of ulceration by angiography was compared with observations during endarterectomy in the first 500 patients recruited into the North American Symptomatic Carotid Endarterectomy Trial. This represents the first multicenter compilation of data on this subject and the largest series of patients with both arteriographic and direct surgical observation. Sensitivity and specificity of detecting ulcerated plaques were 45.9% and 74.1%, respectively. The positive predictive value of identifying an ulcer was 71.8%. These results remained unchanged with differing degrees of carotid stenosis and were confirmed by analyses based on receiver operating characteristic (ROC) methodology. The area under the ROC curve (Az) was estimated to be 0.61 (95% confidence interval, 0.55 to 0.67). These observations from a multicenter study confirm that little agreement exists between angiography and surgical observation in detecting carotid plaque ulceration.

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Section: Discussionmentioning

confidence: 69%

“…Some prefer the reports of microscopic examinations, 8 but the detection of the smallest discontinuity in the endothelium makes this method an impractical standard to be followed.…”

Section: Discussionmentioning

confidence: 99%

Angiographic detection of carotid plaque ulceration. Comparison with surgical observations in a multicenter study. North American Symptomatic Carotid Endarterectomy Trial.

Streifler

Eliasziw

Fox

et al. 1994

Stroke

144

View full text Add to dashboard Cite

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“…However, the results of these studies have been very variable, even between studies using the same imaging criteria, such as the Gray-Weale scale of ultrasound echogenicity [26, 28, 29, 30]or angiographic plaque surface morphology [13, 14, 15, 16, 20, 22], and correlation has sometimes been poor. It is uncertain to what extent this might have been due to variability in the quality of the histological assessment.…”

Section: Discussionmentioning

confidence: 99%

“…However, the results of such studies, even those of intra-arterial angiography, have been highly variable [12]. While some studies seem to show, for example, that angiographic ulceration does represent plaque rupture [13, 14, 15, 16], or that ultrasound echolucency is representative of a plaque filled with lipid and haemorrhage [17, 18, 19], other studies have shown poor agreement between radiological and pathological findings [20, 21, 22, 23, 24]. It has been suggested that these discrepancies may be due to variability in the interpretation of the imaging [25, 26].…”

Section: Introductionmentioning

confidence: 99%

Reproducibility of Histological Assessment of Carotid Plaque: Implications for Studies of Carotid Imaging

Lovett

Gallagher²,

Rothwell

2004

Cerebrovasc Dis

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Background: Thromboembolism from carotid plaque is an important cause of stroke. Identification of unstable plaque would therefore be clinically useful. Unfortunately, studies of carotid plaque imaging have shown poor agreement with histology. However, this may be due to inconsistent methods and the variability of assessments of carotid plaque histology, rather than inadequate imaging. Methods: We assessed the reproducibility of histological assessment in 60 plaques, and section-to-section variability along the length of 26 plaques. Results: Kappa values ranged from 0.35 to 0.89 and from 0.44 to 0.68, respectively, for intra- and inter-observer reproducibility. There was considerable section-to-section variability within plaques. Conclusions: The accuracy of imaging of carotid plaque morphology will be underestimated unless variability in the histology assessment is taken into account.

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“…Of 4 published studies that have reported some comparison with histological assessment, 21-24 2 provide only qualitative results, 23,24 and 2 reported only comparisons between angiographic ulceration and histological plaque rupture. 21,22 We have therefore performed the largest study of this kind (128 carotid plaques) to determine which of 10 histological features are associated with assessments of plaque ulceration on angiography. We have also investigated the histological significance of plaque surface irregularity and ulcers of different types.…”

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confidence: 99%

Histological Correlates of Carotid Plaque Surface Morphology on Lumen Contrast Imaging

et al. 2004

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Background-Carotid angiographic plaque surface morphology is a powerful risk factor for stroke and systemic vascular risk. However, the underlying pathology is unclear, and a better understanding is required both to evaluate other forms of carotid imaging and to develop new treatments. Previous studies comparing angiographic plaque surface morphology with pathology have been small and unblinded, and the vast majority assessed only the crude macroscopic appearance of the plaque. We performed the first large study comparing angiographic surface morphology with detailed histology. Methods and Results-Carotid plaque surface morphology was classified as ulcerated, irregular, or smooth on 128 conventional selective carotid artery angiograms from consecutive patients undergoing endarterectomy for severe symptomatic stenosis. Blinded angiographic assessments were compared with 10 histological features recorded on detailed microscopy of the plaque using reproducible semiquantitative scales. Angiographic ulceration was associated with plaque rupture (Pϭ0.001), intraplaque hemorrhage (Pϭ0.001), large lipid core (Pϭ0.005), less fibrous tissue (Pϭ0.003), and increased instability overall (Pϭ0.001). For example, angiographically ulcerated plaques were much more likely than smooth plaques to be ruptured (ORϭ15.4, 95% CIϭ2.7 to 87.3, PϽ0.001), show a large lipid core (ORϭ26.7, 95% CIϭ2.6 to 270, PϽ0.001) or a large hemorrhage (ORϭ17.0, 95% CIϭ2.0 to 147, Pϭ0.02). The equivalent odds ratios for angiographically irregular versus smooth plaque were 6.3 (1.3 to 31, Pϭ0.02), 6.7 (1.5 to 30, Pϭ0.008), and 9.2 (1.1 to 77, Pϭ0.02), respectively. Conclusions-In contrast to previous studies based on macroscopic assessment, we found very strong associations between detailed histology and carotid angiographic plaque surface morphology. Plaque surface morphology on carotid angiography is a highly sensitive marker of plaque instability. Studies of the predictive value of MR-and CT-based lumen contrast plaque surface imaging are required.

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Correlative Angiographic and Pathologic Findings in the Diagnosis of Ulcerated Plaques in the Carotid Artery

Cited by 20 publications

References 23 publications

Angiographic detection of carotid plaque ulceration. Comparison with surgical observations in a multicenter study. North American Symptomatic Carotid Endarterectomy Trial.

Angiographic detection of carotid plaque ulceration. Comparison with surgical observations in a multicenter study. North American Symptomatic Carotid Endarterectomy Trial.

Reproducibility of Histological Assessment of Carotid Plaque: Implications for Studies of Carotid Imaging

Histological Correlates of Carotid Plaque Surface Morphology on Lumen Contrast Imaging

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