title: Ex vivo characterization of carotid plaques by intravascular ultrasonography and virtual histology: concordance with real plaque pathomorphology.
abstract: BACKGROUND
  The purpose of this study was to evaluate the accuracy of carotid plaque characterisation by virtual histology using intravascular ultrasonography (VH-IVUS) by comparing the results with real morphology.
  
  
  METHODS
  Following elective carotid endarterectomy (CEA), atherosclerotic plaques from 36 patients (19 asymptomatic, 17 symptomatic) underwent ex-vivo VH-IVUS examination. Afterwards, tissue specimens were fixed with formalin and embedded in paraffin. Atherosclerotic lesions were characterised following hematoxylin/eosin (HE) and Elastin van Gieson (EvG) staining using AHA classification (stages I to VIII). The plaque composition, cellularity, severity of inflammation, and atheroma-associated macrophages and foam cells were compared with virtual histology.
  
  
  RESULTS
  Patients with symptomatic carotid artery stenosis showed most commonly lesion type IV-V (N.=9; 52.9%), followed by type VI (N.=3; 17.6%) and type VII (N.=3, 17.6%), type VIII (N.=1; 5.9%) and type I-III (N.=1; 5.9%). In asymptomatic patients with the main lesion was type VII (N.=8; 42.1%), followed by type I-III (N.=4; 21.1%), type IV-V (N.=3, 15.8%) and type VIII (N.=1; 5.3%). The composition of unstable lesions differed significantly in symptomatic patients compared to asymptomatic subjects (70.1% vs. 31.6%, P=0.03). The concordance between the histological results and the VH-IVUS classification was 86.1% (Cohen`s kappa of 0.72).
  
  
  CONCLUSIONS
  In the present study, our findings demonstrated significant correlation between true plaque composition determined by histology and VH-IVUS. Thus, IVUS might be useful as an additional diagnostic method to detect patients with unstable rupture-prone plaques.
authors: Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar der Technischen Universitaet Muenchen, Munich, Germany.
authors: Martina
authors: M
authors: Fuchs
authors: Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar der Technischen Universitaet Muenchen, Munich, Germany.
authors: Peter
authors: P
authors: Heider
authors: Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar der Technischen Universitaet Muenchen, Munich, Germany - J.Pelisek@lrz.tum.de.
authors: Jaroslav
authors: J
authors: Pelisek
authors: Department of Neurology, Klinikum Rechts der Isar der Technischen Universitaet Muenchen, Munich, Germany.
authors: Holger
authors: H
authors: Poppert
authors: Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar der Technischen Universitaet Muenchen, Munich, Germany.
authors: Henning H
authors: HH
authors: Eckstein
mesh_terms: D000368:Aged; D019540:Area Under Curve; D058070:Asymptomatic Diseases; D001706:Biopsy; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016894:Endarterectomy, Carotid; D005260:Female; D005355:Fibrosis; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D018084:Ultrasonography, Interventional