title: Symptomatic carotid atherosclerotic disease: correlations between plaque composition and ipsilateral stroke risk.
abstract: OBJECTIVE
  For symptomatic patients with carotid artery stenosis, the risk benefit for surgical intervention may vary among patient groups. Various modalities of plaque imaging have been promoted as potential tools for additional risk stratification, particularly in patients with moderate stenosis. However, it remains uncertain to what extent carotid plaque components predict risk of future ipsilateral ischemic stroke.
  
  
  METHODS
  In 2 large atherosclerotic carotid plaque biobank studies, we related histological characteristics of 1640 carotid plaques with a validated risk model for the prediction of individual 1- and 5-year stroke risk.
  
  
  RESULTS
  No significant heterogeneity between the studies was found. Predicted 5-year stroke risk (top versus bottom quartile) was related to plaque thrombus (odds ratio, 1.42; 95% confidence interval, 1.11-1.89; P=0.02), fibrous content (0.65; 0.49-0.87; P=0.004), macrophage infiltration (1.41; 1.05-1.90; P=0.02), high microvessel density (1.49; 1.05-2.11; P=0.03), and overall plaque instability (1.40; 1.05-1.87; P=0.02). This association was not observed for cap thickness, calcification, intraplaque hemorrhage, or lymphocyte infiltration. Plaques removed within 30 days of most recent symptomatic event were most strongly correlated with predicted stroke risk.
  
  
  CONCLUSIONS
  Features of the vulnerable carotid plaque, including plaque thrombus, low fibrous content, macrophage infiltration, and microvessel density, correlate with predicted stroke risk. This study provides a basis for plaque imaging studies focused on stroke risk stratification.
authors.affiliation: Stroke Prevention Research Unit, Nuffield Dept. of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
authors.forename: Dominic Pj
authors.initials: DP
authors.lastname: Howard
authors.affiliation: Experimental Cardiology Laboratory, University Medical Center Utrecht, The Netherlands.|Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: Guus W
authors.initials: GW
authors.lastname: van Lammeren
authors.affiliation: Stroke Prevention Research Unit, Nuffield Dept. of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Rothwell
authors.affiliation: Stroke Prevention Research Unit, Nuffield Dept. of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
authors.forename: Jessica N
authors.initials: JN
authors.lastname: Redgrave
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: Frans L
authors.initials: FL
authors.lastname: Moll
authors.affiliation: Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Jean-Paul Pm
authors.initials: JP
authors.lastname: de Vries
authors.affiliation: Experimental Cardiology Laboratory, University Medical Center Utrecht, The Netherlands.
authors.forename: Dominique Pv
authors.initials: DP
authors.lastname: de Kleijn
authors.affiliation: Experimental Cardiology Laboratory, University Medical Center Utrecht, The Netherlands.
authors.forename: Hester M
authors.initials: HM
authors.lastname: den Ruijter
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: Gert Jan
authors.initials: GJ
authors.lastname: de Borst
authors.affiliation: Experimental Cardiology Laboratory, University Medical Center Utrecht, The Netherlands.
authors.forename: Gerard
authors.initials: G
authors.lastname: Pasterkamp
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000209:etiology*; D002340:Carotid Artery Diseases / Q000150:complications / Q000473:pathology; D016893:Carotid Stenosis / Q000150:complications / Q000473:pathology*; D005260:Female; D006470:Hemorrhage / Q000150:complications / Q000473:pathology; D006801:Humans; D008214:Lymphocytes / Q000473:pathology; D008264:Macrophages / Q000473:pathology*; D008297:Male; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000150:complications / Q000473:pathology*; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000473:pathology*; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D013927:Thrombosis / Q000150:complications / Q000473:pathology*; D061205:Vascular Calcification / Q000150:complications / Q000473:pathology
keywords: acute stroke; carotid plaque