Carotid Plaque Reduction After Medical Treatment
In 2000, a 45-year-old woman came to our service for a cardiovascular assessment. The patient had been treated for 2 years with pravastatin, 20 mg/day, for a case of hypercolesterolemia (220 mg/dL). She was normotensive, was a nonsmoker, and had a negative history for diabetes mellitus, stroke, myocardical infarction, and cardiovascular diseases. All of her laboratory tests (hemochromo, coagulation screening, renal and liver function) and instrumental parameters (ECG, echocardiography) were negative. Color Doppler ultrasound (CDU; Duplex Ultrasound Scanner ProSound SSD-5000 with a 7.5-Mhz B-mode and 5-Mhz Doppler linear-array transducer, Aloka) showed a soft plaque localized on the anterior wall at 1 cm proximal to the right carotid bifurcation. The plaque gave a homogeneous echographic appearance with a regular surface, with a 56% diameter reduction (Figure 1). The degree of stenosis was assessed using the common carotid methods (CC), defined as [(1 − B/D) × 100%].
The patient was given oral medication with 500 lipidic units sulodexide (1 cp/day × 20 days/month × 3 years), antiplatelet therapy with 200 mg indobufene (1 cp/day), and 20 mg pravastatin (1 cp/day). During the 3-year follow-up, with 6 months’ of CDU controls, the plaque progressively modified its degree of stenosis and echographic pattern. Figure 2 shows a 50% diameter reduction, Figure 3 shows a 40% diameter reduction, and Figure 4 shows a 30% diameter reduction. At the end of the 3-year follow-up (see Figure 5), the plaque had progressively modified its degree of stenosis and echographic pattern, from 56% soft to 24% dense plaque.