Intraplaque hemorrhage.
This prospective study, which correlated the findings at carotid surgery with the preoperative symptoms, indicates that the occurrence of an intraplaque hemorrhage is an important event in the manifestation of significant carotid artery disease. Almost all of the patients with TIAs had intraplaque hemorrhages and breaks in the endothelium, thereby exposing the hemorrhage to the arterial lumen and providing a source of embolization. The asymptomatic patients in this study had fewer intraplaque hemorrhages, and only 8 per cent had an identifiable source of embolization. It would thus appear from the pathologic study of the plaques harvested at surgery that the cause of TIAs is embolization of intraplaque hemorrhagic material and not platelets and fibrin, which gather on the surface of irregular plaques. We question the use of antiplatelet drugs in the treatment of TIAs, as they could increase the occurrence of intraplaque hemorrhages.
D000368:Aged; D001766:Blindness / Q000601:surgery; D002340:Carotid Artery Diseases / Q000473:pathology* / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000473:pathology*; D002561:Cerebrovascular Disorders / Q000601:surgery; D004691:Endarterectomy; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000473:pathology; D002546:Ischemic Attack, Transient / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies