Carotid plaque surface echogenicity predicts cerebrovascular events: An Echographic Multicentric Swiss Study
Journal Paper/Review - Jul 18, 2022
Sztajzel Roman F, Hirt Lorenz, Medlin Friedrich, Burow Annika, Kägi Georg, Kapauer Monika, Vehoff Jochen, Lovblad Karl O, Curtin Francois, Bonvin Christophe, Baumgartner Ralf W, Engelter Stefan T, Bonati Leo H, Mono Marie-Luise, Slezak Agnieska, Kurmann Rebekka, Nedeltchev Krassen, Gensicke Henrik, Traenka Christopher, Lyrer Philippe A
BACKGROUND AND PURPOSE
To determine the prognostic value for ischemic stroke or transitory ischemic attack (TIA) of plaque surface echogenicity alone or combined to degree of stenosis in a Swiss multicenter cohort METHODS: Patients with ≥60% asymptomatic or ≥50% symptomatic carotid stenosis were included. Grey-scale based colour mapping was obtained of the whole plaque and of its surface defined as the regions between the lumen and respectively 0-0.5, 0-1, 0-1.5, and 0-2 mm of the outer border of the plaque. Red, yellow and green colour represented low, intermediate or high echogenicity. Proportion of red color on surface (PRCS) reflecting low echogenictiy was considered alone or combined to degree of stenosis (Risk index, RI).
We included 205 asymptomatic and 54 symptomatic patients. During follow-up (median/mean 24/27.7 months) 27 patients experienced stroke or TIA. In the asymptomatic group, RI ≥0.25 and PRCS ≥79% predicted stroke or TIA with a hazard ratio (HR) of respectively 8.7 p = 0.0001 and 10.2 p < 0.0001. In the symptomatic group RI ≥0.25 and PRCS ≥81% predicted stroke or TIA occurrence with a HR of respectively 6.1 p = 0.006 and 8.9 p = 0.001. The best surface parameter was located at 0-0.5mm. Among variables including age, sex, degree of stenosis, stenosis progression, RI, PRCS, grey median scale values and clinical baseline status, only PRCS independently prognosticated stroke (p = 0.005).
In this pilot study including patients with at least moderate degree of carotid stenosis, PRCS (0-0.5mm) alone or combined to degree of stenosis strongly predicted occurrence of subsequent cerebrovascular events.