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Rivista di Angiologia

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2003 September;22(3):284-9


lingua: Inglese

Carotid plaque morphology and cerebrovascular events

Carra G., Visonà A., Bonanome A., Lusiani L., Pesavento R., Bortolon M., Pagnan A.

Depart­men­t of Vas­cu­lar Med­i­cine, Inter­nal Med­i­cine and Gen­er­al Med­i­cine, Uni­ver­sity of Padua, Civil Hos­pi­tal, Cas­tel­fran­co Vene­to (TV), Italy


Aim. ­Beside the ­degree of sten­o­sis, ­plaque mor­phol­o­gy ­obtained by the B mode ultra­sound tech­nique has been con­sid­ered to ­define the ­plaque at risk for cereb­ro­vas­cu­lar ­events, and a sub­set of ­patients who ­deserve more ­strict sur­veil­lance. Our aim was to eval­u­ate the rela­tion­ship ­between ­plaque mor­phol­o­gy, pro­gres­sion of sten­o­sis, and the devel­op­ment of new cereb­ro­vas­cu­lar ­events.
Meth­ods. We fol­lowed up by carot­id ­duplex scan 230 asymp­to­mat­ic ­patients, eval­u­at­ing the ­degree and pro­gres­sion of inter­nal carot­id (ICA) ste­nos­es and ­plaque mor­phol­o­gy of the ath­e­ros­cle­rot­ic ­lesions.
­Results. Dur­ing the fol­low-up peri­od (­median 32 month, range 6-125 ­months) 7% of ­patients devel­oped ischem­ic neu­ro­log­i­cal ­events of which 1.7% was a ­stroke. Of these ­events, only 5.7% cor­re­lat­ed with carot­id ­lesions. The new neu­ro­log­i­cal ­events cor­re­lat­ed with the ­degree and pro­gres­sion of ste­nos­es, with a non homo­ge­ne­ous ech­o­graph­ic appear­ance and irreg­u­lar sur­face. The pro­gres­sion of the ­degree of ste­nos­es was the param­e­ter that cor­re­lat­ed the most with the devel­op­ment of new neu­ro­log­ic symp­toms. Nev­er­the­less, the ­lesions that pro­gressed mod­i­fied their ech­o­graph­ic pat­tern from homo­ge­ne­ous to non homo­ge­ne­ous in 78% of cases. Irreg­u­lar sur­face and high ­degree of ste­nos­es more than the base­line ech­o­graph­ic pat­tern seem to cor­re­late with ­plaque pro­gres­sion.
Con­clu­sion. Our fol­low-up study con­firmed that ICA sten­o­sis is a ­benign con­di­tion: very few ­strokes clear­ly cor­re­lat­ed to the sten­o­sis were ­observed. Nev­er­the­less, the major pre­dic­tors of risk for cereb­ro­vas­cu­lar ­events, ­besides the ­degree of ste­nos­es, are the pro­gres­sion of the ­degree of sten­o­sis, irreg­u­lar sur­face and non-homo­ge­ne­ous ech­o­graph­ic appear­ance.

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