Document Detail


Carotid plaque morphology correlates with presenting symptomatology.
MedLine Citation:
PMID:  9620139     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: In carotid artery disease, correlation of carotid plaque morphology with the patient's presenting symptoms has drawn conflicting conclusions. The purpose of this series was to correlate carotid plaque characteristics with the presenting symptoms from a large cohort of patients who underwent operation for carotid artery disease.
METHODS: From a series of 1252 consecutive patients who underwent carotid endarterectomy, presenting symptoms were divided into three groups: transiently symptomatic (transient ischemic attack [TIA] or amaurosis fugax), prior stroke, and asymptomatic. Plaque characteristics, including ulceration, intraplaque hemorrhage, and degree of stenosis, were recorded prospectively for 1008 procedures. All endarterectomy specimens were inspected during the procedure, and plaque characteristics were recorded immediately after operation.
RESULTS: There was a higher incidence of plaque ulceration in the transiently symptomatic and prior stroke groups (391 of 508 [77%] and 91 of 115 [79%]) than in the asymptomatic cohort (231 of 385 [60%]; p < 0.0001, chi2 test). There was no significant difference in the incidence of plaque hemorrhage between the transiently symptomatic and prior stroke patients compared with the asymptomatic patients. There was no statistical difference for ulcerated plaque or plaque hemorrhage between the transiently symptomatic and prior stroke group. Intraplaque hemorrhage occurred more frequently in patients with high-grade stenosis (90% to 99%) than in those with less than 90% stenosis (202 of 299 [68%] versus 97 of 299 [32%]; p = 0.01, chi2 test).
CONCLUSIONS: On gross examination of the carotid specimen in the operating room, plaque ulceration correlates with an initial presentation of amaurosis fugax, TIA, or prior stroke compared with patients operated on for asymptomatic disease. The presence of intraplaque hemorrhage is associated with more advanced stenosis of the internal carotid artery. These findings suggest that plaque morphology does play an important role in the presentation of carotid artery disease.
Authors:
A E Park; W J McCarthy; W H Pearce; J S Matsumura; J S Yao
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  27     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  1998 May 
Date Detail:
Created Date:  1998-06-29     Completed Date:  1998-06-29     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  872-8; discussion 878-9     Citation Subset:  IM    
Affiliation:
Department of Orthopaedic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Ill, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Arteriosclerosis / pathology*,  physiopathology,  surgery
Blindness / physiopathology
Carotid Artery Diseases / pathology*,  physiopathology,  surgery
Carotid Artery, Internal / pathology
Carotid Stenosis / pathology,  physiopathology
Cerebrovascular Disorders / physiopathology
Cohort Studies
Diabetes Complications
Endarterectomy, Carotid
Female
Hemorrhage / pathology
Humans
Hypertension / complications
Incidence
Ischemic Attack, Transient / physiopathology
Male
Middle Aged
Prospective Studies
Smoking / adverse effects
Ulcer / pathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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