The correlation of ultrasonic carotid plaque morphology and carotid plaque hemorrhage: clinical implications.
BACKGROUND
This study examined the importance of ultrasonic plaque morphology and its correlation to the presence of intraplaque hemorrhage and clinical implications.


METHODS
One hundred fifty-two carotid plaques associated with > or = 50% internal carotid artery stenoses in 135 patients who had carotid endarterectomies were characterized ultrasonographically into irregular/ulcerative, smooth, heterogeneous, homogeneous, or not defined. All plaques were examined pathologically for the presence of intraplaque hemorrhage.


RESULTS
The ultrasonic morphology of the plaques included 63 with surface irregularity (41%), 48 smooth (32%), 59 heterogeneous (39%), 52 homogeneous (34%), and 41 not defined (27%). Intraplaque hemorrhage was present in 57 of 63 (90%) irregular plaques and 53 of 59 (90%) heterogeneous plaques, in contrast to 13 of 48 (27%) smooth plaques and 17 of 52 (33%) homogeneous plaques (P < .001). Fifty-three of 63 (84%) irregular plaques and 47 of 59 (80%) heterogeneous plaques had transient ischemic attack (TIA)/stroke symptoms, in contrast to 9 of 48 (19%) for smooth plaques and 15 of 52 (29%) for homogeneous plaques (P < .001).


CONCLUSIONS
Irregular and/or heterogeneous carotid plaques are more often associated with intraplaque hemorrhage and neurologic events. Therefore, ultrasonic plaque morphology may be helpful in selecting patients for carotid endarterectomy.
Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA.
A F
AF
AbuRahma
P D
PD
Kyer
P A
PA
Robinson
R S
RS
Hannay
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000209:etiology; D016894:Endarterectomy, Carotid; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018615:Ultrasonography, Doppler, Color