Regular Article
The Relationship between Carotid Plaque Composition, Plaque Morphology, and Neurologic Symptoms

https://doi.org/10.1006/jsre.1995.1051Get rights and content

Abstract

Variations in plaque composition could make carotid artery plaques prone to ulceration, subintimal hemorrhage, plaque progression, or embolization and, thus, increase the risk of ipsilateral ischemic neurologic events. Seventy-eight carotid endarterectomy specimens from 74 patients (38 symptomatic and 36 asymptomatic) were analyzed. Prior to analysis, 43 of the 78 plaques were divided into sections based on disease severity and examined by light microscopy for surface ulceration and subintimal hemorrhage. Extracted lipid, cholesterol, collagen, and calcium content were determined in all 78 plaques and compared to clinical presentation and/or morphologic observations. Plaques removed from symptomatic patients contained more extracted lipid and cholesterol than those from asymptomatic patients. In addition, compared to the remainder of the plaque, the most stenotic portion of the plaque contained more cholesterol, more calcium, and less collagen. Finally, irrespective of clinical presentation, plaque sections found to have surface ulceration and subintimal hemorrhage contained more cholesterol and less collagen than plaques without these changes. Lipid-laden plaques with low levels of collagen are associated with plaque ulceration, subintimal hemorrhage, and ischemic neurologic symptoms. This suggests that plaque composition may he an important factor in the pathophysiology of carotid atherosclerosis.

References (0)

Cited by (107)

  • A review of computational methods applied for identification and quantification of atherosclerotic plaques in images

    2016, Expert Systems with Applications
    Citation Excerpt :

    The composition of atherosclerotic plaques has been addressed as an important factor for evaluating the risks of plaque rupture, as well as risks for embolization and neurological events. Histological analysis of the carotid specimens has proved a higher amount of lipid and cholesterol components in symptomatic plaques when compared to asymptomatic ones (Seeger et al., 1995). Unstable plaques associated with majority of strokes contain features such as hemorrhage, large lipid cores, thrombus and plaque inflammation (Salem et al., 2014).

  • Features of unstable carotid plaque during and after the hyperacute period following TIA/stroke

    2013, European Journal of Vascular and Endovascular Surgery
    Citation Excerpt :

    So how should these findings be interpreted? Studies16–18 have shown that a high risk plaque characteristically demonstrates a large lipid core, thin or ruptured cap and marked inflammation in response to healing. This tends to reduce with time.

  • Carotid intima-media thickness (cIMT) and plaque from risk assessment and clinical use to genetic discoveries

    2012, Perspectives in Medicine
    Citation Excerpt :

    Atherosclerosis, including plaque formation, represents a dynamic process involving a complex cascade of inflammatory events from lipid deposition to plaque calcification [35]. There is conflicting evidence about the effect of calcified carotid plaque on cardiovascular events [34,36–38]. Echolucent, fatty plaques are considered more harmful, since they are less stable and therefore more prone to rupture [39].

View all citing articles on Scopus
View full text