Association between carotid plaque composition assessed by multidetector computed tomography and cerebral embolism after carotid stenting

BACKGROUND: The stroke is leading cause of death and severe disability worldwide. Atherosclerosis is responsible for over 30% of all ischemic strokes. It has been recently discovered that plaque morphology may help predict the clinical behavior of carotid atherosclerosis and determine the risk of stroke. The noninvasive imaging techniques have been developed to evaluate the vascular wall in an attempt to identify “vulnerable plaques”.AIM: The purpose is to investigate the diagnostic accuracy of ultrasound, multidetector computed tomography and magnetic resonance imaging in the identification of plaque components associated with plaque vulnerability.MATERIAL AND METHODS: One hundred patients were admitted for carotid endarterectomy for high grade carotid stenosis. We defined the diagnostic value of B-mode ultrasound of carotid plaque in a half, and the accuracy of multidetector computed tomography and magnetic resonance imaging, in the other group, for detection of unstable carotid plaque. The reference standard was histology.RESULTS: Sensitivity of ultrasound, multidetector computed tomography and magnetic resonance imaging is 94%, 83% and 100%, and the specificity is 93%, 73% and 89% for detection of unstable carotid plaque.CONCLUSION: The ultrasound has high accuracy for diagnostics of carotid plaque morphology, magnetic resonance imaging has high potential for tissue differentiation and multidetector computed tomography determines precisely degree of stenosis and presence of ulceration and calcifications. The three noninvasive imaging modalities are complementary for optimal evaluation of the morphology of carotid plaque. This will help to determine the risk of stroke and to decide on the best treatment – carotid endarterectomy or carotid stenting.

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The Role of 64/128-Slice Multidetector Computed Tomography to Assess the Progression of Coronary Atherosclerosis

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s20606 ◽

2015 ◽

Vol 9 ◽

pp. CMC.S20606 ◽

Cited By ~ 1

Author(s):

Sherif W. Ayad ◽

Eman M. Elsharkawy ◽

Salah M. Eltahan ◽

Mohamed A. Sobhy ◽

Reem H. Laymouna

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Chest Pain ◽

Multidetector Computed Tomography ◽

Coronary Atherosclerosis ◽

Plaque Progression ◽

Plaque Composition ◽

History Of ◽

Over Time

Objectives We studied the progression of coronary atherosclerosis over time as detected by multidetector computed tomography (MDCT) in relation to risk factors and plaque composition. Background Studies using MDCT are limited to the assessment of the degree of stenosis without taking into consideration the plaque composition that is seen by MDCT. Methods This study included 200 patients, complaining of chest pain and referred to do 64/128-contrast–enhanced MDCT for the second time, and both studies were retrieved and evaluated for the presence of plaque, plaque type, vessel wall remodeling, percent area, and diameter stenosis and compared in both studies. Plaque progression over time and its association with risk factors were determined. Results We included 200 patients, and 348 plaques were detected by 64/128 MDCT. The duration between follow-up and baseline studies was 25.9 ± 19.2 month. In all, 200 plaques showed progression (57.47%), 122 were stable (35.06%), and 26 regressed (7.47%). In longitudinal regression analysis, the presence of history of diabetes mellitus and dyslipidemia and the absence of intraplaque calcium deposits were independently associated with plaque progression over time ( P < 0.0001). Conclusion Coronary plaque burden of patients with chest pain and no history of acute coronary syndrome significantly increased over time. Progression is dependent on plaque composition and cardiovascular risk factors. Larger studies and longer follow-up period are needed to confirm the determinant factors for plaque progression.

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