​Laura Capoccia, Francesco Speziale, Enrico Sbarigia, Ivano P. Renzi, Andrea Esposito, Paolo Fiorani
Department of Surgery "P.Stefanini," Vascular Surgery Division, Policlinico Umberto I, University "La Sapienza," Rome, Italy.

OBJECTIVES: Carotid plaque composition and surface are important features that must be considered when recruiting patients for carotid revascularization. The aim of this study is to relate carotid plaque surface studied by Duplex ultrasound with neurological symptoms and brain ischemic lesions in a prospectively collected database of neurologically symptomatic patients affected by carotid stenosis ≥50% and treated by carotid endarterectomy (CEA) within 2 weeks from onset of symptoms.

METHODS: From 2001 to 2010 data on carotid plaque surface, neurological symptoms evaluated by NIHSS, ischemic brain lesions detected at CT scans were recorded together with clinical and demographic data in 203 symptomatic patients submitted to urgent CEA. Patients were grouped according to carotid plaque surface (smooth, irregular, ulcerated), NIHSS group score before surgery (0 or TIA, 1-3, 4-6, ≥7) and presence of ischemic lesions at preoperative CT scans for analysis. Significance threshold was set at p<0.05.

RESULTS: Eighty-three patients out of 203 presented preoperative ischemic brain lesions (40.9%). In 48.3% of patients an irregular plaque surface was recorded, in 41.8% a ulcerated surface and in 9.9% a smooth surface. At between NHISS groups analysis ulcerated plaque surface was more frequent in TIA patients (p=0.05). In those patients the presence of ulcer in the plaque surface was strongly related to absence of ischemic brain lesions (p=0.05). In stroke patients (NIHSS>0) the ulcerated or irregular plaque surface was slightly significantly associated to presence of preoperative brain ischemic lesions, particularly in NIHSS 1-3 group patients (p=0.08).

CONCLUSIONS: Aside from stenosis percentage, neurological transient and permanent brain symptoms are highly related to carotid plaque surface. Ulcerated carotid plaque surface can be responsible for plaque’s micro-debris embolization or fresh thrombus formation whose brain damage mechanisms can lead to different neurological symptoms and CT scan findings.

AUTHOR DISCLOSURES: L. Capoccia, Nothing to disclose; A. Esposito, Nothing to disclose; P. Fiorani, Nothing to disclose; I. P. Renzi, Nothing to disclose; E. Sbarigia, Nothing to disclose; F. Speziale, Nothing to disclose.

Posted April 2012