+ Resolve Article
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter

+ Translate
+ Subscribe to Site Feed
GeoScience Most Shared ContentMost Shared Content

Atheroma plaque of the carotid bifurcation: how to identify an "active" lesion?

, : Atheroma plaque of the carotid bifurcation: how to identify an "active" lesion?. Revista Portuguesa de Cardiologia 18(7-8): 699-708

The identification of carotid atheromatous plaques associated to a higher neurologic risk may be important in therapeutic decision making for asymptomatic patients and symptomatic patients with 50%-70% stenosis. The introduction of high-definition ultrasonography (HDU) and computer-assisted image analysis provides the possibility of a standard, objective and detailed characterization of the structure of the carotid plaque. The aim of this study is to analyse the relationship between the ultrasonographic characteristics of a group of plaques and the risk of associated cerebrovascular events and cerebral infarction. One hundred carotid bifurcation plaques (in 68 patients) were studied for the presence of ipsilateral cerebrovascular events. In 61 patients (87 plaques), a correlation with CT scan for the presence of cerebral infarction was possible. The lesions were studied by HDU (ATL-HDI 3000) and digitalized for computer-assisted standardization of the image. The analysis included the appreciation of the histogram of the image gray-scale pixel distribution by use of commercial software Adobe Photoshop 3.0. The parameters analysed for global echogenicity were the median of the histogram and the percentage of percentile 40 hypoechogenic pixels (40). Statistical analysis was made with STATA 4.0 software with categorical variables analysed by chi-square and Fisher's exact test and continuous variables analysed by variance analysis and Student's t test. Thirty eight (38%) plaques were symptomatic and 34 (39.1%) were associated to cerebral infarction. The degree of stenosis was > 70% in 51%; between 50 and 69% in 27% and < 50% in 22%. The mean of the median and P40 values was 33.9 and 60.3% in the symptomatic and 46.8 (p = 0.005) and 46.6% (p = 0.001) in the asymptomatic plaques respectively. In the plaques associated to cerebral infarction, it was 32.7 and 61.6% respectively, and in the ones with negative CT scan, it was 44.6 (p = 0.005) and 48.1% (p = 0.002). The mean of the median in the plaques vs. degree of stenosis was: > 70%--33.3; 50-69%--45.1; < 49%--57.7 (p < 0.001). In the series the cut-off point for the median value was 32 and for P40 it was 43 (for any degree of stenosis): G1--plaques < 32 (echolucent); G2--plaques > 32 (echogenic). In G1 symptoms occurred in 60% of the plaques and in 26% of the plaques in G2 (p = 0.0001). CT scan was positive in 66% of the echolucent plaques and in 25% of the echogenic plaques (p = 0.0238). 1. The more echolucent plaques are associated with a significantly higher neurological risk. 2. The plaques associated with higher degrees of stenosis are more echolucent. 3. The use of a standard and objective methodology in the analysis of the echographic structure of carotid plaques is important and limits the known intra and inter-observer variability of subjective appreciation.


PMID: 10466371

Other references

Sapozhnikov V.V., 1992: Hydrochemical characteristics of the Baltic Sea. Oceanology 31(6): 703-707

Buchanan, R.L.; Edelson, S.G.; Boyd, G., 1999: Effects of pH and acid resistance on the radiation resistance of enterohemorrhagic Escherichia coli. The effects of pH and the induction of pH-dependent stationary-phase acid resistance on the radiation resistance of Escherichia coli were determined for seven enterohemorrhagic strains and one nonenterohemorrhagic strain. The isolates were grown i...

Hu, W.; Li, F.; Mahavadi, S.; Murthy, K.S., 2009: Upregulation of RGS4 expression by IL-1beta in colonic smooth muscle is enhanced by ERK1/2 and p38 MAPK and inhibited by the PI3K/Akt/GSK3beta pathway. Initial Ca(2+)-dependent contraction of intestinal smooth muscle is inhibited upon IL-1beta treatment. The decrease in contraction reflects the upregulation of regulator of G protein signaling-4 (RGS4) via the canonical inhibitor of NF-kappaB kina...

Patil, DN.; Jadhav, BV., 2003: One new species of the genus Cotugnia Diamare, 1893. (Cestoda: Davaineidae, Braun, 1900). As C. Guptae n. sp. from Columba livia at Shewali Taluka-Sakri, District Dhule, (M.S.) India. Rivista di Parassitologia. Agosto; 202: 161-164

Oliveira, E.J.; Craig, W.; Davey, M.R.; Power, J.B., 1996: Plant regeneration pathways in Stylosanthes macrocephala. Journal of Experimental Botany 47(SUPPL ): 89-90

Almeida, M.A.F. de; Geden, C.J.; Prado, A.P. do, 2002: Influence of feeding treatment, host density, temperature, and cool storage on attack rates of Tachinaephagus zealandicus (Hymenoptera: Encyrtidae). Tachinaephagus zealandicus Ashmead is a gregarious endoparasitoid that attacks third instars of muscoid flies, including house flies, Musca domestica L. A colony of this parasitoid was established from samples collected from a poultry farm in Sant...

Lemmer, P.; Gunkel, M.; Weiland, Y.; Müller, P.; Baddeley, D.; Kaufmann, R.; Urich, A.; Eipel, H.; Amberger, R.; Hausmann, M.; Cremer, C., 2009: Using conventional fluorescent markers for far-field fluorescence localization nanoscopy allows resolution in the 10-nm range. We present a novel technique of far-field localization nanoscopy combining spectral precision distance microscopy with widely used fluorochromes like the Green Fluorescent Protein (GFP) derivatives eGFP, EmGFP, Yellow Fluorescent Protein (YFP) and...

Chamberlain, K.; Briens, M.; Jacobs, J.H.; Clark, S.J.; Pickett, J.A., 2012: Use of honey bees (Apis mellifera L.) to detect the presence of Mediterranean fruit fly (Ceratitis capitata Wiedemann) larvae in Valencia oranges. When fruit deteriorates a characteristic profile of volatile chemicals is produced that is different from that produced by healthy fruits. The identification of such chemicals allows the possibility of monitoring the fruit for early signs of deter...

Hensinger, R.N., 2006: Impending danger: community-acquired methicillin-resistant Staphylococcus aureus. Journal of Pediatric Orthopedics 26(6): 701-702

Usnarska Zubkiewicz, L.; Kuliczkowski, K., 1998: Prognostic factors and five year survival in patients with plasma cell dyscrasias from lower Silesia Region. The pretreatment characteristics of patients with plasma cell neoplasms from Lower Silesia Region treated between 1986 and 1996 at the Department of Haematology Medical University in Wroclaw and prognostic factors associated with long-term surviva...