This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Carotid artery plaque morphology is related to time since last neurological event. BJS 2000; 87: 495-496.
Published: 6th December 2002
Authors: J. W. B. Senaratne, A. Handa, L. J. Hands, J. Collin, P. J. Morris, F. R. Green et al.
Background
Conflicting conclusions have been drawn regarding the relationship of plaque morphology and symptomatology of carotid atherosclerosis. Previous papers have examined the nature of symptoms and the degree of stenosis. This study determined whether plaque morphology was related to symptomatology with regard to the nature, timing and amount of symptoms, and the degree of stenosis.
Method
In 60 consecutive carotid endarterectomies the symptoms (transient ischaemic attack (TIA), cerebrovascular accident (CVA), amaurosis fugax (AF), other), time between last neurological event and surgery, number of episodes and the degree of stenosis were recorded prospectively. The plaques removed at surgery were examined immediately and by histology. The macroscopic appearance was recorded as stable (fibrous or fatty plaque with or without calcification) or unstable (plaques with ulceration, rupture or thrombosis). Microscopic grading as either stable or unstable was done using the criteria of a consensus document (Circulation 1995).
Results
There were more CVAs (11 of 34 versus four of 26), and fewer TIAs (17 of 34 versus 16 of 26) and instances of AF (six of 34 versus six of 26) when the plaque was deemed unstable, but this was not statistically significant. Twenty of 34 patients with an unstable plaque had an event in the 6 weeks preceding surgery compared with one of 26 with a stable plaque (P < 0·001). Unstable plaques were associated with more events (12 of 34 patients had more than three events compared with one of 26 with a stable plaque; P = 0·012). Degree of stenosis was not related to plaque morphology. In a logistic regression model, the only predictive factor for finding an unstable plaque at surgery was the timing of the last neurological event (P < 0·001).
Conclusion
The importance of time since the last neurological event in predicting plaque instability is shown. This factor may help to clarify future studies attempting to determine plaque morphology before operation by ultrasonography. © 2000 British Journal of Surgery Society Ltd
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