Circulation. 2001;104:68-73
doi: 10.1161/hc2601.091704
doi: 10.1161/hc2601.091704
(Circulation. 2001;104:68.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Ultrasonic Echolucent Carotid Plaques Predict Future Strokes
From the Department of Internal Medicine and Therapeutics (A8) (H. Hashimoto, K.K., H. Hougaku, Y.S., M.S., Y.N., M.M., M.H.), and Department of Diagnostic Medicine (S.I., H.Y.), Osaka University Graduate School of Medicine, Osaka, Japan.
Correspondence to Drs Hiroyuki Hashimoto and Masayasu Matsumoto, Division of Strokology, Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. E-mail mlg{at}dadlnet.dk
Background—We tested prospectively the hypothesis that stroke development can be predicted by echolucency of carotid atherosclerotic plaques in previously symptomatic and asymptomatic patients.
Methods and Results—We
followed incidence of ipsilateral ischemic strokes for 4.4
years in 111 asymptomatic and 135 symptomatic
patients with 
50% relevant carotid artery stenosis. At
inclusion, echogenicity of carotid plaques and degree of
stenosis were evaluated with high-resolution B-mode ultrasound
with computer-assisted image processing and Doppler ultrasound,
respectively. We observed 44 ipsilateral ischemic strokes. In
symptomatic patients, relative risk of ipsilateral
ischemic stroke for echolucent versus echorich plaques was 3.1
(95% CI, 1.3 to 7.3), whereas for 80% to 99% versus 50% to 79%
stenosis, the relative risk was 1.4 (95% CI, 0.7 to 3.0).
Relative to symptomatic patients with echorich 50% to 79%
stenotic plaques, those with echorich 80% to 99%
stenotic plaques, echolucent 50% to 79% stenotic
plaques, and echolucent 80% to 99% stenotic plaques had
relative risks of ipsilateral ischemic strokes of 3.1 (95%CI,
0.7 to 14), 4.2 (95% CI, 1.2 to 15), and 7.9 (95% CI, 2.1 to 30),
equivalent to absolute risk increases of 11%, 18%, and 28%. This was
not observed in previously asymptomatic
patients.
Conclusions—Echolucent
plaques causing 50% diameter stenosis by Doppler
ultrasound are associated with risk of future stroke in
symptomatic but not asymptomatic individuals.
This suggests that measurement of echolucency, together with degree of
stenosis, may improve selection of patients for carotid
endarterectomy.
Key Words: arteriosclerosis • stroke • carotid arteries • ultrasonics • follow-up studies
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