Symptoms, stenosis and carotid plaque morphology. Is plaque morphology relevant?
OBJECTIVE
To study the relationship between carotid plaque morphology and the degree of stenosis on Duplex ultrasonography and symptoms.


METHODS
Prospective open clinical study.


METHODS
2,590 patients with 5,180 carotid arteries were scanned, 4,560 were initially analysed in terms of symptoms but 54 were excluded, leaving a total of 4,258.


RESULTS
Localising symptoms were present with respect to 1,342 vessels (29.4%). Two-thirds of symptomatic patients had normal carotid arteries. Tight stenosis (80-99%) was more likely to be associated with symptoms than low-grade (20-79%) stenosis (chi 2 = 28.0, p < 0.0001). Plaque type was identified in 1,558 bifurcations (36.6%). Heterogeneous type I & II plaques accounted for one third of plaques. There was a relationship between plaque morphology and degree of stenosis. At < 20% stenosis only 4.4% of plaques were heterogeneous whereas at 80-99% stenosis 84.5% of plaques were heterogeneous. Amaurosis fugax was the only symptom that had any association with a particular plaque morphology. Seventy-two percent of plaques associated with this symptom were heterogeneous in nature.


CONCLUSIONS
Carotid plaque morphology and degree of internal carotid stenosis are mutually dependent factors and both reflect the severity of atherosclerotic disease. Plaque morphology does not add to the sensitivity of stenosis in predicting the presence of symptoms.
Holdsworth
R J
RJ
Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee, Scotland.
McCollum
P T
PT
Bryce
J S
JS
Harrison
D K
DK
D001766:Blindness / Q000209:etiology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology; D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000209:etiology; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology; D002546:Ischemic Attack, Transient / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015356:Retinal Artery Occlusion / Q000209:etiology; D012680:Sensitivity and Specificity; D017585:Ultrasonography, Doppler, Transcranial