Morphological classification of mobile plaques and their association with early recurrence of stroke.
BACKGROUND
The present study investigated the frequency and morphological characteristics of carotid mobile plaques and examined the relationship between carotid mobile plaques and recurrent strokes.


METHODS
The study included 94 consecutive acute stroke patients with large-artery atherosclerosis associated with extracranial carotid stenosis. We investigated the presence of mobile plaques by carotid ultrasonography and classified patients into two groups (mobile group and non-mobile group). We compared backgrounds, MRI and ultrasonographic findings, neurological severity on admission and at discharge, and the rate of early recurrent stroke between both groups.


RESULTS
Mobile plaques were detected in 12 patients (12.8%). There were four types of mobile plaques: (1) the jellyfish-type plaque, in which the fibrous cap fluctuated like a jellyfish; (2) the streaming-band-type plaque, in which the string attached to the plaque was swaying; (3) the mobile-thrombus-type plaque, in which a mobile mass was attached to the plaque surface, and (4) the fluctuating-ulcer-type plaque, which contained a mobile substance in the plaque ulcer. Although National Institutes of Health Stroke Scale (NIHSS) scores on admission were less severe in the mobile group than in the non-mobile group (median 1 vs. 4, respectively; p = 0.004), the rate of early recurrent stroke was significantly higher in the mobile group than in the non-mobile group (33.3 vs. 7.3%, respectively; p = 0.022). There were no significant differences in NIHSS scores at discharge between groups.


CONCLUSIONS
Morphologically, several types of mobile plaques were detected in consecutive patients with acute stroke associated with carotid stenosis. Mobile plaques are strongly associated with an early recurrence of stroke.
Department of Cerebrovascular Diseases, Cerebrovascular Center and Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Kyushu University, Fukuoka, Japan. toshi.ogata1@gmail.com
Toshiyasu
T
Ogata
Masahiro
M
Yasaka
Yoshiyuki
Y
Wakugawa
Takanari
T
Kitazono
Yasushi
Y
Okada
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000209:etiology* / Q000473:pathology; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007564:Japan; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology* / Q000473:pathology; D014463:Ultrasonography