Carotid artery plaque echomorphology and its association with histopathologic characteristics

• Published in: Journal of vascular surgery 2018-12, Vol.68 (6), p.1772-1780
• Main Authors: Spanos, Konstantinos, Tzorbatzoglou, Ioannis, Lazari, Paraskevi, Maras, Dimitrios, Giannoukas, Athanasios D.
• Format: Article
• Language: English
• Subjects: Aged; Biopsy; Carotid Artery, Internal - diagnostic imaging; Carotid Artery, Internal - pathology; Carotid Artery, Internal - surgery; Carotid plaque; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - epidemiology; Carotid Stenosis - pathology; Carotid Stenosis - surgery; Cross-Sectional Studies; Endarterectomy, Carotid; Female; Greece - epidemiology; Histopathology; Humans; Male; Middle Aged; Plaque texture features; Plaque, Atherosclerotic; Predictive Value of Tests; Prevalence; Retrospective Studies; Risk Factors; Rupture, Spontaneous; Severity of Illness Index; Stroke - epidemiology; Ultrasonography, Doppler, Duplex; Ultrasound
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2018.01.068

The aim of the study was to determine the association of ultrasonic texture features (severity of stenosis, grey scale median, plaque area, juxtaluminal black area [JBA], and discrete white areas) previously shown to be independent predictors for stroke with established histologic features of plaque instability. A cross-sectional study was performed involving 70 patients scheduled for carotid endarterectomy. Before surgery, carotid plaque texture features were obtained with ultrasound after normalization using commercially available software (LifeQ Medical, Nicosia, Cyprus). After carotid endarterectomy, histologic features (number of macrophages [CD68 staining], severity of angiogenesis [CD31 staining], smooth muscle cell [SMC] numbers, size of lipid core, thickness of the fibrous cap, presence of intraplaque hemorrhage, plaque rupture, and instability) also were studied. Symptomatic (n = 20) and asymptomatic (n = 50) patients were comparable in terms of internal carotid stenosis (mean stenosis, 86%; range, 60%-99%) and prevalence of risk factors except for total cholesterol (which was higher in the symptomatic group; P = .023). A low grey scale median and the presence of discrete white areas were associated with an increased number of macrophages (P < .001 and P < .001, respectively), increased neovascularization (P = .019 and P