Spotty Carotid Plaques Are Associated with Inflammation and the Occurrence of Cerebrovascular Symptoms

• Published in: Cerebrovascular diseases extra Vol. 8; no. 1; pp. 16 - 25
• Main Authors: Halak, Sanela, Östling, Gerd, Edsfeldt, Andreas, Kennbäck, Cecilia, Dencker, Magnus, Gonçalves, Isabel, Asciutto, Giuseppe
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01-01-2018; Karger Publishers
• Subjects: Atherosclerosis; Calcification; Cardiac and Cardiovascular Systems; Cerebrovascular disease; Clinical Medicine; Cytokines; Family medical history; Histology; Inflammation; Kardiologi; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Neurologi; Neurology; Original Paper; Plaque; Stroke; Tomography; Ultrasonic imaging; Ultrasound in stroke; Veins & arteries; Ultrasound in stroke; Cerebrovascular disease; Plaque
• ISSN: 1664-5456; 1664-5456
• DOI: 10.1159/000485258

Background: Echolucent carotid plaques have been related to an increased risk of ischemic cerebrovascular events. The aim of the present study was to evaluate whether a new objective ultrasonographic parameter, the statistical geometric feature (SGF), reflecting spottiness of carotid plaques, can be associated with cerebrovascular symptoms and with a rupture-prone plaque phenotype. Methods: The plaques of 144 patients who underwent carotid endarterectomy were included in this study. SGF and plaque area were estimated by outlining the plaque on ultrasound (US) images. The correlation coefficient for inter- and intraobserver variability was 0.69 and 0.93, respectively. The SGF values were normalized to the degree of stenosis (SGF/DS). The plaques collected at surgery 1 day after the US were analyzed histologically, and inflammatory markers and matrix metalloproteinases (MMPs) were measured. Results: Patients with ipsilateral hemispheric symptoms had higher SGF/DS compared to patients without symptoms (0.82 [0.59–1.16] vs. 0.70 [0.56–0.89], p = 0.01). Analysis of plaque components revealed a positive correlation between SGF/DS and the percentage of the plaque area stained for lipids, macrophages, and hemorrhage. A correlation was also found between SGF/DS and plaque expression of interleukin-6, monocyte chemoattractant protein-1, macrophage inflammatory protein-1β, vascular endothelial growth factor A, C-C motif chemokine 3 and 20, and MMP-9. An inverse correlation was found with plaque levels of osteoprotegerin. Conclusions: The present study supports the concept that spottiness is a feature of the carotid plaques rich in inflammation and can be associated with the typical phenotype of high-risk plaques.