title: Intravascular frequency-domain optical coherence tomography assessment of carotid artery disease in symptomatic and asymptomatic patients.
abstract: OBJECTIVE
  The goal of this study was to investigate carotid plaque characteristics in symptomatic versus asymptomatic patients with the use of nonocclusive optical coherence tomography (OCT).
  
  
  BACKGROUND
  The identification of asymptomatic patients with carotid disease who are at risk of stroke remains a challenge. There is an increasing awareness that plaque characteristics may best risk-stratify this population. We hypothesized that OCT, a new high-resolution (∼ 10 μm) imaging modality, might be useful for the identification of low-risk versus high-risk carotid plaque features and help us to understand the relationship between carotid diameter stenosis and plaque morphology to ischemic stroke.
  
  
  METHODS
  Fifty-three patients undergoing diagnostic carotid angiography were studied with OCT. Data analysis was carried out by imaging experts who were unaware of the clinical characteristics of the study population.
  
  
  RESULTS
  Plaque with American Heart Association type VI complicated features was more common in symptomatic than asymptomatic patients (74.1% vs. 36.4%, p = 0.02). This was largely driven by differences in the incidence of thin-cap fibroatheroma with rupture (40.7% vs. 13.6%, p = 0.056) and thrombus (67.7% vs. 36.4%, p = 0.034). Conversely, non-type VI plaques were more common in asymptomatic than symptomatic patients (63.6% vs. 25.9%, p = 0.02). No association between the degree of stenosis and plaque morphology was identified.
  
  
  CONCLUSIONS
  This retrospective analysis of carotid OCT data supports the hypothesis that the evaluation of carotid plaque characteristics with this high-resolution imaging technique has the potential to alter the understanding and treatment of carotid artery disease.
authors.affiliation: Baptist Heart and Vascular Institute, Central Baptist Hospital, Lexington, Kentucky. Electronic address: Michael.Jones1@bhsi.com.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jones
authors.affiliation: Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio; Department of Interventional Cardiology, Pitangueiras Hospital, Jundiai, SP, Brazil.
authors.forename: Guilherme F
authors.initials: GF
authors.lastname: Attizzani
authors.affiliation: Baptist Heart and Vascular Institute, Central Baptist Hospital, Lexington, Kentucky.
authors.forename: Curtis A
authors.initials: CA
authors.lastname: Given
authors.affiliation: Baptist Heart and Vascular Institute, Central Baptist Hospital, Lexington, Kentucky.
authors.forename: William H
authors.initials: WH
authors.lastname: Brooks
authors.affiliation: Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Ganocy
authors.affiliation: Baptist Heart and Vascular Institute, Central Baptist Hospital, Lexington, Kentucky.
authors.forename: Christian N
authors.initials: CN
authors.lastname: Ramsey
authors.affiliation: Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Fujino
authors.affiliation: Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Hiram G
authors.initials: HG
authors.lastname: Bezerra
authors.affiliation: Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Costa
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D041623:Tomography, Optical Coherence / Q000379:methods*
keywords: carotid artery disease; optical coherence tomography; stroke