Identification of Patients with a Histologically Unstable Carotid Plaque Using Ultrasonic Plaque Image Analysis
A total of 126 patients were included in the study. Based on the presence and extent of histological features including haemorrhage, thrombus, fibrous tissue, lipid core, inflammation, neovascularity, foam cells, and cap rupture, 39 plaques were graded as predominantly stable, while 87 were predominantly unstable. Unstable plaques were associated with a plaque area >95 mm2 (OR 4.15; 95% CI 1.34–12.8 p = .009), a juxtaluminal black area >6 mm2 (OR 2.77; 95% CI 1.24 to 6.17 p = .01) and a GSM <25 (OR 3.76; 95% CI 1.14–12.39). Logistic regression indicated that patients with the first two features had a 90% probability of having a histologically unstable plaque. The model was used to calculate the probability of having an unstable plaque in each patient. The receiver operating characteristic curve using the p value was 0.68 (95% CI 0.59–0.78).
Comments:
This is for me very relvant in asymptomatic patients, mainly to justify the operation; and hence the risk of giving a stroke. High risk plaques are DANGEROUS; it does correlate with thrombus in the plaque; but not with development of symptoms (notice this).