Determinants of carotid plaque instability: Echoicity versus heterogeneity

Objective: to identify the echoicity and heterogeneity of carotid plaques a ssociated with ipsilateral symptomatic and asymptomatic neurovascular prese ntations. Design: cross-sectional study. Materials: a total of 113 patients, with 127 symptomatic and asymptomatic p laques, were studied. Methods: the duplex images of the plaques were analysed echoically in a com puter by means of Grey Scale Median (GSM) [hypoechoic (low GSM), hyperechoi c (high GSM)]. The presence of absence of at least tow plaque regions withi n the plaque area being echoically uniform (no variation of echoicity), occ upying each at least 10% of the plaque ara and having GSM difference greate r than the plaque GSM was evaluated to distinguish the heterogeneous (prese nce of this pattern) from the homogeneous (absence of this pattern) plaques . Results: the symptomatic status was associated wit plaques of low median GS M (10.5) and 88% prevalence of the homogeneous pattern as contrasted with t he asymptomatic status that was associated with high median GSM (28) and 65 % prevalence of the homogeneous pattern [(p = 0.001 (GSM), p = 0.003 (heter ogeneity)]. Conclusions: symptomatic plaques were associated with hypoechoic and predom inant homogeneous echo-pattern whereas the asymptomatic ones were associate d with hyperechoic and less predominant homogeneous pattern.