Evolution of Atherosclerotic Carotid Plaque Morphology: Do Ulcerated Plaques Heal? A Serial Multidetector CT Angiography Study

Abstract

Background: Atherosclerotic carotid plaque rupture may lead to thromboembolization, causing transient ischemic attack or ischemic stroke. Carotid plaque ulceration on angiography is associated with plaque rupture. Although healing of ruptured plaques has been described in coronary arteries, little is known about the natural development of plaque ulcerations in carotid arteries. We therefore explored the evolution of carotid plaque surface morphology with serial multidetector CT angiography (MDCTA). Methods: From a registry of patients with transient ischemic attack or minor ischemic stroke, we selected 83 patients who had undergone serial MDCTA of the carotid arteries. Arteries subjected to revascularization procedures between the two scans were excluded (n = 11). Plaque surface morphology was classified as smooth, irregular or ulcerated on both baseline and follow-up MDCTA. Progression (i.e. development of irregularities or ulceration) and regression (i.e. disappearance of irregularities or ulceration) in morphology were evaluated. Results: The mean time interval between the MDCTA scans was 21 ± 13 months. At baseline, 28 (18%) arteries were normal, 124 (80%) contained atherosclerotic plaque and 3 (2%) were occluded. Plaque surface morphology was smooth in 86 arteries (55%), irregular in 23 (15%) and ulcerated in 15 (10%). At follow-up, surface morphology was unchanged in 88% of arteries, had progressed in 8% and regressed in 4%. Most importantly, plaque morphology remained unchanged in most ulcerated plaques (10/15; 67%). One ulcerated plaque had progressed, whereas 4 had regressed. New ulcerations had developed in 2 nonulcerated plaques. Conclusion: MDCTA allows evaluation of temporal changes in atherosclerotic carotid plaque morphology. Plaque surface morphology remained unchanged in most arteries. Carotid ulcerations persist for a long time, and may remain a potential source of thromboembolism.

Multi dedektör bilgisayarlı tomografi ile karotid arter plaklarında kontrastlanma miktarlarının saptanması

“…Adraktas et al (18) and Van Gils et al (19) were able to reveal the risk factors showing temporal alterations on the plaques of the patients with carotid stenosis who were followed up with MDCT. The use of ionized radiation and the artifacts resulting from the calcifications and metallic implants limit in general the utilization of CT.…”

Basal Cerebral Computed Tomography as Diagnostic Tool to Improve Patient Selection in Asymptomatic Carotid Artery Stenosis

“…As in the present report, ultrasound is the cheapest, reproducible and less invasive tool with a reliable association with plaque morphology. 21,22,[26][27][28][29] Also, histological findings according to AHA level of lesion progression have been critically associated to plaque imaging tools (CT, grayscale median, optical coherence tomography, ultrasound, and platelet scintigraphy). 30,31 In asymptomatic patients, the association of carotid plaque at risk and a cerebral CT scan pattern A could be employed to identify a subgroup which benefits more from carotid artery treatment.…”

Advances in MRI for the evaluation of carotid atherosclerosis

“…63 The high stress level in acutely and recently symptomatic patients as quantified by these studies may shed light on the extremely high recurrent rate for TIA patients in the early stage. Following the acute event, plaque healing 64,65 may occur with a smoother lumen surface 66 or a thicker and stronger FC 67,68 that may reduce the stress level and stabilize the lesion. However, such remodelling may promote plaque progression and eventually turn into a vulnerable lesion.…”