B-mode ultrasonographic characterization of carotid atherosclerotic plaques in symptomatic and asymptomatic patients.
OBJECTIVE
To identify features on B-mode ultrasonography (US) prevalent in symptomatic plaques and correlate these findings with histopathologic markers of plaque instability.


METHODS
Carotid endarterectomy (CEA) plaques from symptomatic and asymptomatic patients with critical stenoses (>70%) were qualitatively assessed using preoperative B-mode US for echolucency and calcific acoustic shadowing. US echolucency was quantitated ex vivo using computerized techniques for gray-scale median (GSM) analysis. Histopathologic correlates for US plaque echolucency (percentage of necrotic core area) and acoustic shadowing (percentage of calcification area) were determined.


RESULTS
Fifty CEA plaques were collected from 48 patients (46 unilateral and two bilateral); 26 of these plaques were from symptomatic patients. Age, degree of stenosis, and atherosclerotic risk factors were similar for the symptomatic and asymptomatic patients. Using preoperative B-mode US, 58%, 35%, and 7% of symptomatic plaques and 18%, 41%, and 41% of asymptomatic plaques were found to be echolucent, echogenic, and calcific, respectively (P < .05). Using ex-vivo B-mode US and GSM analysis, symptomatic plaques were more echolucent (41 +/- 19) than asymptomatic plaques (60 +/- 13), P < .03. A strong inverse correlation was found between the percent plaque necrotic area core and GSM (R = -0.9, P < .001). Percentage of calcification area in plaques with acoustic shadowing was 66% and only 27% in those without acoustic shadowing (P < .05).


CONCLUSIONS
Using B-mode US, symptomatic plaques are more echolucent and less calcified than asymptomatic plaques and are associated with a greater degree of histopathologic plaque necrosis. Such features are indicative of plaque instability and should be considered in the decision-making algorithm when selecting patients with high-grade asymptomatic carotid stenosis for intervention.
Grogan
Jennifer K
JK
Vascular Section, Department of Surgery, University of Chicago, IL 60637, USA. hbassiou@surgery.bsd.uchicago.edu
Shaalan
Wael E
WE
Cheng
Hongwei
H
Gewertz
Bruce
B
Desai
Tina
T
Schwarze
Gretchen
G
Glagov
Seymour
S
Lozanski
Laurie
L
Griffin
Andrea
A
Castilla
Maria
M
Bassiouny
Hisham S
HS
D000465:Algorithms; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000601:surgery; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D016009:Chi-Square Distribution; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D016014:Linear Models; D008297:Male; D012372:ROC Curve; D012307:Risk Factors; D018615:Ultrasonography, Doppler, Color