Asymptomatic Carotid Artery Stenosis: Identification of Subgroups with Different Underlying Plaque Characteristics

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• 作者：G.W. van Lammeren^a ; ^b ; ^e ; A.G. den Hartog^a ; ^e ; G. Pasterkamp^b ; A. Vink^c ; J.-P.P.M. de Vries^d ; F.L. Moll^a ; G.J. de Borst^a ; ^{G.J.deBorst-2@umcutrecht.nl}
• 关键词：Asymptomatic disease ; Carotid stenosis ; Atherosclerosis ; Carotid endarterectomy ; Atherosclerotic plaque ; Risk factors
• 刊名：European Journal of Vascular and Endovascular Surgery
• 出版年：2012
• 期刊代码：122_10785884
• 类别：med
• 出版时间：June, 2012
• 卷：43
• 期：6
• 页码：632-636
• 文件大小：231 K

摘要

Objectives

Optimal surgical treatment of patients with asymptomatic carotid artery stenosis (ACAS) remains a matter of debate. Established definitions of ACAS include: (1) patients who never suffered from ipsilateral cerebrovascular events (group 1) or (2) patients who suffered from ipsilateral cerebrovascular events more than 6 months prior to revascularisation (group 2). Cerebrovascular symptoms are closely related to underlying carotid plaque composition and therefore we investigated potential plaque differences between these definition-based subgroups.

Design

Cross-sectional analysis of a longitudinal prospective biobank study.

Material and methods

Carotid atherosclerotic plaques from 264 asymptomatic patients were harvested during endarterectomy, and subjected to histopathological examination. Patients were divided into two groups: group 1: truly asymptomatic (n聽=聽182), and group 2: patients with ipsilateral events more than 6 months before carotid endarterectomy (CEA) (n聽=聽82).

Results

Patients in group 1 had relatively more stable plaque characteristics as compared with patients in group 2, with a higher median plaque smooth muscle cell content (2.1 (0.0-18.7) vs. 1.6 (0.0-14.4); P聽=聽0.036), a higher proportion of heavily calcified plaques (67.7%(123/182) vs. 48.8%(40/82); P聽=聽0.005) and less frequently intraplaque haemorrhages (11.5%(21/182) vs. 30.5%(25/82); P聽=聽0.001).

Conclusion

Different plaque characteristics within subgroups of ACAS patients can be identified based on reported past ipsilateral events, which might result in adjusted future treatment strategies.