title: Patients with recurrent ischaemic events from carotid artery disease have a large lipid core and low GSM.
abstract: OBJECTIVE
  The aim of the current study was to determine whether computerised ultrasound plaque analysis could identify features predictive of an increased risk of early recurrent events after symptom onset.
  
  
  METHODS
  Between August 2008 and December 2010, 158 consecutive symptomatic patients undergoing carotid endarterectomy (CEA) had their plaques harvested at CEA and then independently scored for markers of histological plaque instability. Duplex ultrasound images recorded prior to CEA were independently assessed using the Iconsoft software.
  
  
  RESULTS
  One hundred and fifty eight recently symptomatic patients underwent CEA with 118 (75%) undergoing their operation within 14 days of their most recent clinical event. Twenty (12.7%) suffered a recurrent cerebral ischaemic event following admission to the vascular unit and before undergoing CEA. Using multivariate stepwise analysis; lipid core (OR 4.00, 95% CI 1.07 to 14.83, P = 0.042) and a low GSM (OR 6.21, 95% CI 1.86 to 20.4, P = 0.003) were independently associated with recurrent cerebrovascular events.
  
  
  CONCLUSIONS
  Within a cohort of patients presenting with recent onset cerebral ischaemic events undergoing CEA, the plaques of patients with recurrent events following admission to hospital had evidence a large lipid core and a low GSM.
authors.affiliation: Vascular Surgery Group, Department of Cardiovascular Sciences, Robert Kilpatrick Clinical Sciences Building, University of Leicester, LE2 7LX, UK. ms447@le.ac.uk
authors.forename: M K
authors.initials: MK
authors.lastname: Salem
authors.forename: R D
authors.initials: RD
authors.lastname: Sayers
authors.forename: M J
authors.initials: MJ
authors.lastname: Bown
authors.forename: K
authors.initials: K
authors.lastname: West
authors.forename: D
authors.initials: D
authors.lastname: Moore
authors.forename: A
authors.initials: A
authors.lastname: Nicolaides
authors.forename: T G
authors.initials: TG
authors.lastname: Robinson
authors.forename: A R
authors.initials: AR
authors.lastname: Naylor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000378:metabolism; D015331:Cohort Studies; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D050356:Lipid Metabolism; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012307:Risk Factors; D018616:Ultrasonography, Doppler, Duplex