CAROTID-ARTERY PLAQUE COMPOSITION - RELATIONSHIP TO CLINICAL PRESENTATION AND ULTRASOUND B-MODE IMAGING

Objective: To correlate B-mode ultrasound findings to carotid plaque h istology. Design: European multicentre study (nine centres). Material and Methods: Clinical presentation and risk factors were recorded and preoperative ultrasound Duplex scanning with special emphasis on B-mod e imaging studies was performed in 270 patients undergoing carotid end arterectomy. Perioperatively macroscopic plaque features were evaluate d and the removed specimens were analysed histologically for fibrous t issue, calcification and 'soft tissue' (primarily haemorrhage and lipi d). Results: Males had more soft tissue than females (p = 0.0006), hyp ertensive patients less soft tissue than normotensive (p = 0.01) and p atients with recent symptoms more soft tissue than patients with earli er symptoms (p = 0.004). There was no correlation between surface desc ription on ultrasound images compared to the surface judged intraopera tively by the surgeon. Echogenicity on B-mode images was inversely rel ated to soft tissue (p=0.005) and calcification ions directly related to echogenicity (p < 0.0001). Heterogeneous plaques contained more cal cification than homogeneous (p = 0.003), however there was no differen ce in content of soft tissue. Conclusion: Ultrasound B-mode characteri stics are related to the histological composition of carotid artery pl aques and to patient's history. These results may imply that patients with distant symptoms may be regarded and treated as asymptomatic pati ents whereas asymptomatic patients with echolucent plaques should be c onsidered for carotid endarterectomy.