(Circulation. 2001;103:2171.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Echolucent Plaques Are Associated With High Risk of Ischemic Cerebrovascular Events in Carotid Stenosis
The Tromsø Study
From the Institute of Community Medicine, University of Tromsø, Norway.
Correspondence to Ellisiv B. Mathiesen, Institute of Community Medicine, University of Tromsø, N-9037 Tromsø, Norway. E-mail ellisiv.mathiesen{at}ism.uit.no
Background—The purpose of the study was to assess in a prospective design whether plaque morphology is associated with risk of ischemic stroke and other cerebrovascular events in subjects with carotid stenosis.
Methods and Results—A
total of 223 subjects with carotid stenosis (123 with 35% to
49% degree of stenosis, 100 with 50% to 99%
stenosis) and 215 control subjects matched by age and sex who
participated in a population health survey at baseline were followed up
for 3 years. Plaque echogenicity was assessed by ultrasound at baseline
and scored as echolucent, predominantly echolucent, predominantly
echogenic, or echogenic. Forty-four subjects experienced 
1
ischemic cerebrovascular events in the follow-up period. Plaque
echogenicity, degree of stenosis, and white blood cell count
were independent predictors of cerebrovascular events. The unadjusted
relative risk for cerebrovascular events was 13.0 (95% CI 4.5 to 37.4)
in subjects with echolucent plaques and 3.7 (95% CI 0.7 to 18.2) in
subjects with echogenic plaques when subjects without stenosis
were used as the reference. The adjusted relative risk for
cerebrovascular events in subjects with echolucent plaques was 4.6
(95% CI 1.1 to 18.9), and there was a significant linear trend
(P=0.015) for higher risk with
increasing plaque echolucency. The adjusted relative risk for a 10%
increase in the degree of stenosis was 1.2 (95% CI 1.04 to
1.4).
Conclusions—Subjects with echolucent atherosclerotic plaques have increased risk of ischemic cerebrovascular events independent of degree of stenosis and cardiovascular risk factors. Subjects at high risk for ischemic vascular events may be identified by ultrasound assessment of plaque morphology.
Key Words: plaque • ultrasonics • carotid arteries • stenosis • stroke • follow-up studies
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