Increase in echogenicity of echolucent carotid plaques after treatment with total triterpenic fraction of Centella asiatica: A prospective, placebo-controlled, randomized trial

The aim of this study was to evaluate whether total triterpenic fraction of Centella asiatica (TTFCA), was effective in modulating collagen production over 12 months, by producing an increase in echogenicity in echolucent car otid plaques. Part I was a pilot study aimed at evaluating the effects of T TFCA on different types of plaques. Part II was a prospective, randomized, placebo-controlled trial aimed at evaluating the effects of TTFCA on hypoec hoic-echolucent plaques. The sonographic examination of carotid plaques was made with high-resolution ultrasound. Capturing, digital image processing, and normalization were standardized, interobserver, intrascanner, gain-lev el variability were standardized using as reference blood (black) for the m ost echolucent parts of the plaque and the adventitia (white) as the most e chogenic part, Normalization of echo texture was obtained and plaque charac terization differentiated echo-texture of plaque associated with events and those that did not cause embolization, thrombosis, or cardiovascular event s. After identifying plaques at higher risk, patients were treated with TTF CA (oral tablets, 60 mg, thrice daily for 12 months) to evaluate whether th is compound, by modulating collagen synthesis, could increase the echogenic ity and therefore the stability of echolucent plaques. Part II was aimed at evaluating the effects of TTFCA on hypoechoic-echolucent plaques, Asymptom atic patients with echolucent plaques (GSM < 18) were treated with TTFCA (6 0 mg, oral tablets three times daily for 12 months) or with comparable plac ebo after informed consent. All patients were also treated with antiplatele t agents. In part 1, at inclusion the GSC in the hypoechoic group was 15 (r ange, 12-18) while in the hyperechoic group it was 26 (range, 24-31); at 6 months it was increased in the hypoechoic group and at 12 months the increa se was significant (19.5; p < 0.05). There was a minor increase in GSM in t he hyperechoic group (30; ns). In part 11 in the treatment group there was a significant difference in GSM (increase) at 12 months (p < 0.05), improve ment in texture (p < 0.05) and a nonsignificant decrease in stenosis. No ch anges were observed in the placebo group. Events were observed in 6.5% of p atients in the TTFCA group and in 11% in the control group (p < 0.05). In c onclusion these observations suggest a positive action of TTFCA on the stab ilization of hypoechoic, low-density carotid plaques.