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Year : 2007  |  Volume : 55  |  Issue : 2  |  Page : 101

The correlation of carotid plaque pathohistological features and neurological symptoms: A meta-analysis of observational studies


Stroke Prevention and Atherosclerosis Research Centre, 1400 Western Rd, London, ON, Canada N6G 2V2

Correspondence Address:
J David Spence
Stroke Prevention and Atherosclerosis Research Centre, 1400 Western Rd, London, ON, Canada N6G 2V2

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.32764

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How to cite this article:
Spence J D. The correlation of carotid plaque pathohistological features and neurological symptoms: A meta-analysis of observational studies. Neurol India 2007;55:101

How to cite this URL:
Spence J D. The correlation of carotid plaque pathohistological features and neurological symptoms: A meta-analysis of observational studies. Neurol India [serial online] 2007 [cited 2019 Dec 16];55:101. Available from: http://www.neurologyindia.com/text.asp?2007/55/2/101/32764


The authors[1] have carried out an important service by their meta-analysis, which strengthens the evidence that plaque characteristics are strongly associated with clinical outcomes. They have shown clearly that ulceration is a feature of plaques that are vulnerable to rupture; intraplaque hemorrhage is also associated with events in their linear analysis. In the search for identifying patients with vulnerable plaque prone to events before their plaques can be examined histologically, it will be necessary to bring forward the recognition of vulnerable plaques to identification before the plaques can be examined histologically. This task will fall to those developing methods for imaging of atherosclerosis.

Although ulcers cannot be seen well by angiography, they can now be reliably detected by three-dimensional ultrasound.[2] Fenster and colleagues are now working on quantifying plaque surface roughness,[3] an approach that may identify vulnerable plaques at an earlier stage. Magnetic resonance imaging (MRI) with multiple sequences has been used to analyze plaque characteristics such as calcification, intraplaque hemorrhage and lipid core,[4] and gray-scale analysis of carotid ultrasound images, though not yet as advanced as MRI, shows promise for revealing features of plaques at risk.[5] Three-dimensional ultrasound is a powerful approach for assessing response to therapy.[6] An interesting approach has been assessment of "hot" plaques by positron emission tomography with fluorodeoxyglucose.[7]

To bridge these two worlds of imaging and histology will require preoperative imaging studies in patients scheduled for endarterectomy; this approach has been used to some extent,[8] but requires more work using multiple imaging modalities, perhaps including transcranial Doppler detection of microemboli, which are strongly predictive of vascular events in patients with asymptomatic carotid stenosis.[9]

 
  References Top

1.Gao P, Zuo-quan C, Jiao Li-qun, Ling F. The correlation of carotid plaque pathohistologic features and neurological symptoms: A meta-analysis of observational studies. Neurol India 2007;55:122-9.  Back to cited text no. 1    
2.Schminke U, Motsch L, Hilker L, Kessler C. Three-dimensional ultrasound observation of carotid artery plaque ulceration. Stroke 2000;31:1651-5.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Fenster A, Landry A, Downey DB, Hegele RA, Spence JD. 3D Ultrasound Imaging of the carotid arteries. Curr Drug Targets Cardiovasc Haematol Disord 2004;4:161-75.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Rutt BK, Clarke SE, Fayad ZA. Atherosclerotic plaque characterization by MR imaging. Curr Drug Targets Cardiovasc Haematol Disord 2004;4:147-59.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Pauletto P, Puato M, Faggin E, Santipolo N, Pagliara V, Zoleo M, et al . Specific cellular features of atheroma associated with development of neointima after carotid endarterectomy: The carotid atherosclerosis and restenosis study. Circulation 2000;102:771-8.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Ainsworth CD, Blake CC, Tamayo A, Beletsky V, Fenster A, Spence JD. 3D ultrasound measurement of change in carotid plaque volume: A tool for rapid evaluation of new therapies. Stroke 2005;36:1904-9.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Rudd JH, Warburton EA, Fryer TD, Jones HA, Clark JC, Antoun N, et al . Imaging atherosclerotic plaque inflammation with [18F]-fluorodeoxyglucose positron emission tomography. Circulation 2002;105:2708-11.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Clarke SE, Hammond RR, Mitchell JR, Rutt BK. Quantitative assessment of carotid plaque composition using multicontrast MRI and registered histology. Magn Reson Med 2003;50:1199-208.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9.Spence JD, Tamayo A, Lownie SP, Ng W, Ferguson GG. Absence of microemboli on transcranial Doppler identifies low-risk patients with asymptomatic carotid stenosis who do not warrant endarterectomy or stenting. Stroke 2005;36:2373-8.  Back to cited text no. 9    




 

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