Objective: To correlate B-mode ultrasound findings to carotid plaque
histology.
Design: European multicentre study (nine centres).
Material and Methods: Clinical presentation and risk factors were
recorded and preoperative ultrasound Duplex scanning with special
emphasis on B-mode imaging studies was performed in 270 patients
undergoing carotid endarterectomy. Perioperatively, macroscopic plaque
features were evaluated and the removed specimens were analysed
histologically for fibrous tissue, calcification and ‘soft tissue’
(primarily haemorrhage and lipid).
Results: Males had more soft tissue than females (p = 0.0006),
hypertensive patients less soft tissue than normotensive (p = 0.01) and
patients with recent symptoms more soft tissue than patients with
earlier symptoms (p = 0.004). There was no correlation between surface
description on ultrasound images compared to the surface judged
intraoperatively by the surgeon. Echogenicity on B-mode images was
inversely related to soft tissue (p = 0.005) and calcification was
directly related to echogenicity (p < 0.0001). Heterogeneous plaques
contained more calcification than homogeneous (p = 0.003), however,
there was no difference in content of soft tissue.
Conclusion: Ultrasound B-mode characteristics are related to the
histological composition of carotid artery plaques and to patient’s
history. These results may imply that patients with distant symptoms may
be regarded and treated as asymptomatic patients whereas asymptomatic
patients with echoluceht plaques should be considered for carotid
endarterectomy. (C) 2011 Published by Elsevier Ltd on behalf of European
Society for Vascular Surgery
