New information on the value of plaque characterisation - Relation to symptoms

This paper reviews the literature on the significance of carotid plaque ech omorphology and degree of stenosis in relation to the different types of ce rebrovascular symptomatology (amaurosis fugax, hemispheric transient ischae mic attacks, stroke) and the asymptomatic status. It provides evidence that amaurosis fugax is associated with hypoechoic and severely stenosed plaque s, the hemispheric transient ischaemic attacks and stroke are associated wi th plaques of intermediate echodensity and stenosis while the asymptomatic status is associated with hyperechoic and moderately stenosed plaques. It lends support to the notion that plaque hypoechoicity is associated with embologenicity. It supports the view that the severe carotid stenosis faci litates the opening of the cerebral collateral circulation and that amauros is fugax is associated with an "opened" cerebral collateral supply as contr asted to the cerebrovascular symptomatology. It proposes the inclusion of t he cerebral collateral circulation as a stroke risk factor along with the p laque echomorphology and the degree of stenosis in the natural history stud ies of asymptomatic individuals with carotid bifurcation plaques.