CAROTID PLAQUE CHARACTERISTICS AND PRESENTING SYMPTOM

Background The importance of identifying features of carotid artery di sease, in addition to degree of stenosis, which predict subsequent str oke is becoming increasingly clear. This study assessed the relationsh ip between carotid plaque characteristics and presenting symptoms. Met hods Some 285 symptomatic (transient ischaemic attack (TIA) 127, amaur osis fugax 58, transient stroke 15, established stroke 55, progressive stroke 11, crescendo TIA 19) and 65 asymptomatic patients were studie d with colour-flow duplex imaging. All patients had 60-99 per cent int ernal carotid stenosis. Carotid plaque morphology (classified accordin g to Gray-Weale) and plaque surface features were assessed. Results Pl aque types I and II were more common in symptomatic patients (83 per c ent ver sus 44 per cent P < 0.0001). Plaque surface was classified as smooth (34 per cent), irregular (44 per cent) or ulcerated (22 per cen t). Ulceration was also more common in symptomatic patients (23 versus 14 per cent, P = 0.04). In symptomatic patients there was no associat ion between presenting symptom and plaque morphology or surface featur es (P = 0.9 and P = 0.8 respectively). On multiple regression analysis plaque morphology did not distinguish between patients who presented with stroke without warning and other symptomatic patients (who had TI A, amaurosis fugax, crescendo TIA or stroke with warning). Conclusion There was an association between echolucent type I and II carotid plaq ues and the presence of symptoms but not their type. Plaque morphology was not characteristic in a subgroup of patients who had stroke witho ut warning. Further prospective study of plaque morphology in asymptom atic patients might help identify high-risk groups.