Ultrasonographic screening for evaluation and follow-up of carotid artery ulceration

doi:10.1016/0002-9610(82)90536-0

The American Journal of Surgery

Volume 144, Issue 6, December 1982, Pages 614-618

https://doi.org/10.1016/0002-9610(82)90536-0 Get rights and content

Abstract

Routine ultrasonographic screening and examination of patients with and without specific symptoms of carotid artery disease now provides greater understanding of the natural history of the disease. In one year, 194 ulcers were detected, classified, and followed. No initially asymptomatic ulcer shallower than 2 mm later became asymptomatic, and it is concluded that a trial of antiplatelet therapy in these patients would be inconclusive. More than a third of the initially asymptomatic ulcers from 2 to less than 4 mm in depth gave rise to lateralizing symptoms that required surgery, The effects of antiplatelet therapy in this vulnerable population could be readily followed by ultrasonographic monitoring. All patients with ulcers 4 mm or more in depth were initially symptomatic and so required surgery.

References (8)

H Javid
Development of carotid plaque
Am J Surg
(1979)
JE Thompson
The development of carotid artery surgery
Arch Surg
(1973)
JA DeWeese et al.
Surgical treatment of occlusive disease of the carotid artery
Ann Surg
(1958)
JE Thompson et al.
Carotid surgery for cerebrovascular insufficiency
Curr Probl Surg
(1978)

There are more references available in the full text version of this article.

Cited by (21)

The role of carotid plaque vulnerability and inflammation in the pathogenesis of acute ischemic stroke
2008, American Journal of the Medical Sciences
Citation Excerpt :
In our study, irregular and ulcerated plaques were detected with greater frequency in the stroke group than in the asymptomatic group. However, other sonographic studies have shown that it was the deep ulceration of plaques and not their surface irregularity, is associated with the presence of symptoms.18 These discordant findings may be related to different definitions of plaque morphology.
Increasing evidences show that disruption of carotid plaque followed by arterio-arterial thromboembolism is an important mechanism in the generation of ischemic stroke. Inflammatory mechanisms play a key role in transforming structurally vulnerable plaques into functionally unstable ones. The purpose of the present study is to evaluate the roles of carotid plaque vulnerability and inflammation in the pathogenesis of acute ischemic stroke.
Fifty-two patients with acute ischemic stroke affecting the anterior circulation (stroke group) and 44 with asymptomatic carotid stenosis (asymptomatic group) were investigated. Duplex ultrasonography was used to evaluate the characteristics of carotid plaque and grading the degree of carotid stenosis. Plaque echogenicity was assessed as echolucent, predominantly echolucent, predominantly echogenic, or echogenic. Plaque surface was classified as smooth, irregular, or ulcerated. All subjects had duplex-determined 50% to 99% carotid stenosis. Serum levels of matrix metalloproteinase-9 (MMP-9), tissue inhibitors of metalloproteinases (TIMP-1), soluble CD40 ligand (sCD40L) and high-sensitivity C-reactive protein (hsCRP) were measured.
Plaques in the stroke group were echolucent or predominantly echolucent, whereas those of the asymptomatic group were predominantly echogenic or echogenic plaques (P < 0.05). Irregular and ulcerated plaques were frequently found in stroke patients, while smooth plaques were frequently detected in asymptomatic patients (P < 0.05). Serum levels of MMP-9, sCD40L, hsCRP were higher in stroke than in asymptomatic patients. By contrast, serum TIMP-1 levels were significantly higher in the asymptomatic than in the stroke group.
The results suggest that inflammation plays a crucial role in carotid plaque vulnerability and, together with carotid plaque morphology, in the pathogenesis of acute ischemic stroke.
Color-flow Doppler-assisted duplex imaging fails to detect ulceration in high-grade internal carotid artery stenosis
1996, Journal of Vascular Surgery
Purpose: Pathoanatomic studies suggest that plaque surface disruption, particularly ulceration, plays a key role in the destabilization of internal carotid artery stenosis. Until now, the validity of color-flow Doppler-assisted duplex imaging in detecting such pathoanatomically defined plaque surface abnormalities is unclear.
Methods: We prospectively determined the interobserver reliability and validity of detecting plaque ulceration by means of preoperative color-flow Doppler-assisted duplex imaging in 43 consecutive patients with high-grade (≥70%) internal carotid artery stenosis, comparing these ultrasonographic findings with pathoanatomic evaluations of the corresponding endarterectomy specimens.
Results: Interobserver reliabilities for detecting carotid plaque ulceration were κ=0.57 for ultrasonography and κ=0.82 for the pathologic reference method. Color-flow Doppler-assisted duplex imaging (observer consensus) failed to detect pathoanatomically defined ulceration (X²=0.43; p=0.51). Likewise, sensitivity, specificity, overall accuracy, and positive predictive value were poor (33%, 67%, 56%, and 46%, respectively).
Conclusions: We conclude from our data that color-flow Doppler-assisted duplex imaging is not a reliable or valid means to identify plaque ulceration in high-grade carotid artery lesions.
The relationship between carotid plaque composition and neurologic symptoms
1987, Journal of Surgical Research
Variations in plaque composition, particularly an increased lipid concentration, could make carotid plaques unstable and prone to embolization. To investigate this hypothesis, 35 carotid bifurcation plaques from 31 patients undergoing carotid endarterectomy (20 symptomatic, 11 asymptomatic) were prospectively analyzed. Plaque total lipid, cholesterol, collagen, and Ca²⁺ content were determined, and the plaque collagen was fractionated into pepsin-soluble collagen (PSC) (indicative of less crosslinked, more recently synthesized collagen) and pepsin-insoluble collagen. Preoperative serum lipid and plasma lipoprotein levels were also obtained in all patients. Results revealed that plaques removed from symptomatic patients contained significantly more total lipid and cholesterol (P < 0.001) than those removed from asymptomatic patients. There was also an increased amount of pepsin-soluble collagen in symptomatic plaques, potentially indicating increased metabolic activity (P < 0.05). In addition, mean plasma low-density lipoprotein cholesterol was higher in symptomatic patients than in asymptomatic patients (P < 0.05). Since lipid-laden plaques can potentially be identified by B-mode ultrasound, it may be important to remove these plaques in asymptomatic patients or, alternatively, to attempt to lower the plaque cholesterol by lipid-lowering maneuvers.
Real-time B-mode venous ultrasound
1984, Journal of Vascular Surgery
The ability of real-time B-mode ultrasound to directly visualize arteries and veins and thereby give anatomic rather than physiologic information is unique among the currently available noninvasive methods of vascular evaluation. The usefulness of this technique for examination of the carotid arteries has been well proven. Little attention, however, has been given to its applicability for deep venous evaluation. Over the past 12 months the veins of 108 upper and 215 lower extremities have been studied with high-resolution real-time ultrasound. The technique and interpretive criteria are presented. Thirty extremities underwent confirmatory venography, and in this group the specificity and sensitivity of the ultrasound were 94% and 100%, respectively. In addition, the age of the thrombi detected was accurately predicted in 93% of this group. These preliminary results suggest that real-time B-mode venous ultrasound is an accurate, clinically useful noninvasive technique for the detection of deep venous thrombosis that complements the more widely used physiologic screening tests. (J VASC SURG 1984;1:465-71.)
Imaging of the ulcerated carotid atherosclerotic plaque: a review of the literature
2017, Insights into Imaging
New criteria for the sonographic diagnosis of a plaque ulcer in the extracranial carotid artery
2012, American Journal of Roentgenology

View all citing articles on Scopus

^☆: Presented at the 34th Annual Meeting of the Southwest Surgical Congress, Coronado, California, April 26–29, 1982.

¹: From the Vascular Laboratory, Good Samaritan Hospital, Phoenix, Arizona.

View full text

Scientific paperUltrasonographic screening for evaluation and follow-up of carotid artery ulceration☆

Abstract

Am J Surg

The development of carotid artery surgery

Arch Surg

Surgical treatment of occlusive disease of the carotid artery

Ann Surg

Carotid surgery for cerebrovascular insufficiency

Curr Probl Surg

Scientific paper
Ultrasonographic screening for evaluation and follow-up of carotid artery ulceration☆