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© 2008 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 27:1313-1319 • 0278-4297

Sonographic Carotid Plaque Morphologic Characteristics and Vascular Risk Factors

Results From a Population Study

Edoardo Vicenzini, MD, PhD, Maria Chiara Ricciardi, MD, Francesco Puccinelli, MD, Marta Altieri, MD, PhD, Nicola Vanacore, MD, Vittorio Di Piero, MD, PhD and Gian Luigi Lenzi, MD

Department of Neurological Sciences (E.V., M.C.R., F.P., M.A., V.D.P., G.L.L.) and National Institute of Epidemiology, National Institute of Health (N.V.), University of Rome, La Sapienza, Rome, Italy.

Address correspondence to Edoardo Vicenzini, MD, PhD, Department of Neurological Sciences, University of Rome, La Sapienza, Viale dell’Università 30, 00185 Rome, Italy. E-mail: edoardo.vicenzini{at}uniroma1.it

Objective. The role of vascular risk factors in atherosclerosis development is well established, whereas risk factors involved in determining plaque vulnerability are still a matter of debate. We investigated the vascular risk factor distribution in patients with carotid plaques. Methods. We consecutively assessed sonographic plaque morphologic characteristics, the degree of stenosis, and the common carotid artery intima-media thickness (IMT) in 1655 patients. Demographic data, a documented history of symptomatic cerebrovascular disease (CVD), and the presence of vascular risk factors were collected. According to literature, heterogeneous hypoechoic plaques with an irregular surface or ulcerations and those with a severe degree of stenosis (≥70%) have been considered "complex" plaques at "major" risk of stroke; homogeneous hyperechoic plaques with smooth surface lesions have been considered "simple" plaques at minor risk. Results. Univariate analysis showed that all vascular risk factors were associated with the presence of carotid atherosclerotic lesions. Multiple logistic regression showed an independent association of hypertension and diabetes with complex plaques, which also had a thicker IMT. A history of CVD was observed more frequently in complex plaques, which had a higher stenosis percentage even after patients with a severe degree of stenosis (≥70%) and indications for carotid surgery were excluded. Conclusions. Hypertension and diabetes are related to a thicker IMT and more severe complex plaques, which may reflect the instability of atherosclerotic process. Because two-thirds of the patients with complex plaques were asymptomatic for CVD, this raises the importance of surveillance sonography to monitor plaque evolution for prevention of symptomatic CVD.

Key Words: carotid atherosclerosis • sonography • stroke prevention • unstable plaques • vascular risk factors

Abbreviations: CVD, cerebrovascular disease • GSM, gray scale median • IMT, intima-media thickness

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Copyright © 2008 by the American Institute of Ultrasound in Medicine.