Carotid plaque gross morphology and clinical presentation: A prospective study of 457 carotid artery specimens

Background and purpose. In carotid artery disease, the relationship between carotid plaque morphology and the patient's neurologic symptoms is reporte dly conflicting. The aim of this study was to correlate gross carotid plaqu e characteristics with the presenting symptoms in a relatively large series of patients who underwent carotid endarterectomy (CEA). Methods. Four hund red and five patients who underwent 461 CEAs were divided into three groups : (1) transiently symptomatic [transient ischemic attack (TIA) or amaurosis fugax]; (2) prior stroke; and (3) asymptomatic. The degree of stenosis bas ed on the preoperative angiograms was used in association with the presenti ng symptoms as the primary criterion in the decision to operate. Carotid pl aque characteristics, including ulcerated plaque (UP), intraplaque hemorrha ge (IH), uncomplicated plaque, and degree of stenosis, were recorded prospe ctively for 457 CEAs, since 4 CEAs were excluded from the study. All CEA sp ecimens were grossly evaluated at surgery. Results. There was a statistical ly higher incidence of UP in transiently symptomatic (P = 0.008) or prior s troke (P = 0.006)patients than in the asymptomatic group. When IH was consi dered independently, its incidence did not differ significantly between the three groups. Previously symptomatic patients tended to have higher-grade stenosis than asymptomatic patients, although the difference failed to reac h statistical significance (P = 0.06). Although the incidences of UP and IH were higher in the higher-grade stenosis group, the difference was again n ot significant. Conclusions Carotid UP correlates closely with an initial p resentation of TIA, amaurosis fugax, or prior stroke, while the association between III and presenting symptoms is less clear, Although there is an in significant trend toward a correlation between the higher degrees of stenos is and the onset of transient symptoms, the degree of stenosis appears unaf fected by the morphology of the plaque. These findings suggest that plaque morphology may play an important role in the presentation of carotid artery disease. (C) 2000 Academic Press.