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International Angiology 2001 March;20(1):51-7


lingua: Inglese

Carotid plaque echogenicity and types of silent CT-brain infarcts. Is there an association in patients with asymptomatic carotid stenosis?

Sabetai M. M., Tegos T. J., Clifford C., Dhanjil S., Belcaro G., Kakkos S., Kalodiki E., Stevens J. M., Nicolaides A. N.

From the Irvine Laboratory for Cardiovascular Investigation and Research, Imperial College School of Medicine at St. Mary’s Hospital, Department of Vascular Surgery, London * Department of Radiology, Imperial College School of Medicine at St. Mary’s Hospital, London, UK


Back­ground. The aim of this study was to iden­ti­fy the dif­fer­enc­es in echog­e­nic­ity and the ­degree of sten­o­sis of asymp­to­mat­ic carot­id ­plaques asso­ciat­ed with dif­fer­ent types of ipsi­lat­er­al ­silent CT-brain ­infarcts.
Meth­ods. Some 273 asymp­to­mat­ic carot­id ­plaques (218 ­patients) caus­ing 50 to 99% sten­o­sis were stud­ied with high-res­o­lu­tion ultra­sound. B-mode imag­es were dig­it­ised and nor­mal­ised by assign­ing cer­tain grey val­ues to blood and adven­ti­tia. The grey scale ­median (GSM) of the ­plaque in the nor­mal­ised image was used to quan­ti­fy echog­e­nic­ity. Every ­patient had a CT-brain scan which an inde­pen­dent neu­ro­ra­diol­o­gist read. The pres­ence of 1) non-lac­u­nar and 2) lac­u­nar ­silent CT-brain ­infarcts ipsi­lat­er­al to the carot­id ­plaque was noted.
­Results. The mean GSM of ­plaques asso­ciat­ed with non-lac­u­nar ­silent CT-brain ­infarcts was 19.6, of ­plaques asso­ciat­ed with lac­u­nar ­infarcts was 35.5 and of those asso­ciat­ed with no ­infarcts was 32 (p=0.008, ANOVA). The mean ­degree of sten­o­sis was 79%, 72% and 73% respec­tive­ly (p=0.1, ANOVA). ­Plaque echog­e­nic­ity (p=0.007) and not the ­degree of sten­o­sis (p=0.07) pre­dict­ed the pres­ence of non-lac­u­nar ­silent CT-brain ­infarcts (logis­tic regres­sion).
Con­clu­sions. Carot­id bifur­ca­tion ­plaques, which are asso­ciat­ed with non-lac­u­nar ­silent CT-brain ­infarcts, are sig­nif­i­cant­ly more hypo­echo­ic than those asso­ciat­ed with lac­u­nar or no ­infarcts. ­Plaques asso­ciat­ed with lac­u­nar ­silent ­infarcts and no ­infarcts have the same echog­e­nic­ity and ­degree of sten­o­sis. These find­ings sug­gest an embol­o­gen­ic mech­a­nism of non-lac­u­nar ­silent CT-brain ­infarcts that may have prog­nos­tic impli­ca­tions in ­patients with asymp­to­mat­ic carot­id sten­o­sis. Pros­pec­tive stud­ies of asymp­to­mat­ic carot­id sten­o­sis ­should ­assess the sig­nif­i­cance of 1) ­plaque echog­e­nic­ity and 2) the pres­ence of dif­fer­ent types of ­silent CT-brain ­infarcts and ather­oem­bol­ic ­stroke.

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