title: Vulnerable plaques in the contralateral carotid arteries in symptomatic patients: a detailed ultrasound analysis.
abstract: OBJECTIVE
  Carotid plaques may represent a generalized atherosclerotic syndrome or a localized disease. The aim of this study was to assess the morphological and textural features of carotid plaques located contralateral to the symptomatic side and compare them with the symptomatic side and with plaques from asymptomatic patients.
  
  
  METHODS
  We studied 66 arteries in 39 patients (mean age 70 ± 7 year, 33% females). Arterial plaques were classified as either symptomatic (n = 30), contralateral to symptomatic (n = 25) or asymptomatic (n = 11). We compared several plaque features between these groups including the mean values of the grey scale median (GSM), entropy, juxtaluminal black area (JBA) without visible echogenic cap, GSM of the JBA and surface irregularity.
  
  
  RESULTS
  The plaques contralateral to symptomatic arteries had similar morphological and textural features to those in the symptomatic arteries. In contrast, they had more vulnerable morphological and textural features than those in asymptomatic arteries: less smooth plaques (12% vs. 55%) and instead more often mildly irregular (60% vs 36%) or markedly irregular (28% vs. 9%; p = 0.03), lower GSM (26.2 ± 8 vs. 49.4 ± 14, p < 0.001) and lower GSM of the JBA (5.0 ± 3.6 vs. 11.4 ± 2.1, p = 0.008). The frequency of entropy and plaque calcification was similar in all groups.
  
  
  CONCLUSIONS
  Symptomatic patients with carotid artery disease seem to have similar morphological and textural features of vulnerability in the symptomatic and the contralateral carotid arteries, which are profound compared with asymptomatic carotid arteries. These findings support the concept of generalized carotid atherosclerotic pathology rather than incidental unilateral disease, and also emphasize a need for aggressive measures for plaque stabilization, particularly in symptomatic patients.
authors: Department of Public Health and Clinical Medicine and Heart Centre, Umeå University, Umeå, Sweden.
authors: Pranvera
authors: P
authors: Ibrahimi
authors: Department of Public Health and Clinical Medicine and Heart Centre, Umeå University, Umeå, Sweden.
authors: Fisnik
authors: F
authors: Jashari
authors: Department of Public Health and Clinical Medicine and Heart Centre, Umeå University, Umeå, Sweden; Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.
authors: Elias
authors: E
authors: Johansson
authors: Department of Biomedical Engineering - Radiation Sciences, Umeå University, Umeå, Sweden.
authors: Christer
authors: C
authors: Gronlund
authors: Department of Public Health and Clinical Medicine and Heart Centre, Umeå University, Umeå, Sweden.
authors: Gani
authors: G
authors: Bajraktari
authors: Department of Public Health and Clinical Medicine and Heart Centre, Umeå University, Umeå, Sweden.
authors: Per
authors: P
authors: Wester
authors: Department of Public Health and Clinical Medicine and Heart Centre, Umeå University, Umeå, Sweden. Electronic address: michael.henein@medicin.umu.se.
authors: Michael Y
authors: MY
authors: Henein
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D016893:Carotid Stenosis / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography
keywords: Carotid artery disease; Gray scale median; Juxtaluminal black area; Plaque vulnerability