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International Angiology 2003 September;22(3):284-9

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: English

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


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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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