title: Carotid plaque characterization by virtual histology intravascular ultrasound related to the timing of carotid intervention.
abstract: OBJECTIVE
  To determine the incidence of vulnerable plaques characterized by virtual histology intravascular ultrasound (VH IVUS) in patients with severe internal carotid artery (ICA) stenosis and its relationship to the timing of protected carotid artery stenting (CAS).
  
  
  METHODS
  The study included 141 patients (119 men; mean age 66.9 ± 9 years) with severe ICA stenosis undergoing CAS with cerebral protection. Patients were classified in 3 groups: 39 symptomatic early CAS (<14 days from clinical symptoms); 58 symptomatic delayed CAS (range 15-180 days), and 44 asymptomatic CAS. Culprit plaque component was evaluated by VH IVUS. A vulnerable plaque was defined by a thin-cap fibroatheroma and/or calcified thin-cap fibroatheroma.
  
  
  RESULTS
  The composite disabling stroke/mortality was 2.1%. The incidence of vulnerable plaques was significantly higher in the symptomatic early CAS group (25/39, 64.1%) than in the symptomatic delayed CAS group (26/58, 44.8%; p=0.048) or the asymptomatic CAS group (14/44, 31.8%; p=0.003). Symptomatic patients showed a significantly higher incidence of vulnerable plaques (52.6%) than asymptomatic patients (31.8%, p=0.022). There were no significant differences between the symptomatic delayed and asymptomatic groups (p=0.129). By clinical subgroup, a vulnerable plaque was observed in 29 (52.7%) of the patients with 55 transient ischemic attacks, 22 (52.4%) of the 42 minor stroke patients, and 14 (31.8%) of the 44 asymptomatic patients (p=0.152).
  
  
  CONCLUSIONS
  The incidence of vulnerable plaques was significantly higher in symptomatic patients, increasing as the intravascular study was performed closer to the index ischemic episode.
authors.affiliation: Department of Radiology and Interventional Neuroradiology, Virgen del Rocio University Hospital, Seville, Spain. ggjandro@gmail.com
authors.forename: Alejandro
authors.initials: A
authors.lastname: González
authors.forename: Antonio
authors.initials: A
authors.lastname: López-Rueda
authors.forename: Isabel
authors.initials: I
authors.lastname: Gutiérrez
authors.forename: Francisco
authors.initials: F
authors.lastname: Moniche
authors.forename: Aurelio
authors.initials: A
authors.lastname: Cayuela
authors.forename: Alejandro
authors.initials: A
authors.lastname: Bustamante
authors.forename: Antonio
authors.initials: A
authors.lastname: Mayol
authors.forename: Jose Ramón
authors.initials: JR
authors.lastname: Gonzalez-Marcos
authors.forename: Alberto
authors.initials: A
authors.lastname: Gil-Peralta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D058070:Asymptomatic Diseases; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000473:pathology; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016009:Chi-Square Distribution; D057505:Embolic Protection Devices; D005260:Female; D005355:Fibrosis; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000473:pathology