Search

An editorial is presented on plaque burden and vulnerable features being at higher risk of cerebrovascular symptoms. Topics include evaluating carotid plaques using computed tomography angiography (CTA) in symptomatic patients with bilateral intraplaque hemorrhage; and computed tomography angiography being quicker and more cost-effective imaging technique than MRI and identifying vulnerable carotid plaque features.

We estimated the value of objective, computerized texture analysis of ultrasonic images in distinguishing carotid plaques associated with neurological ipsilateral symptoms (amaurosis fugax [AmF; n = 30], transient ischemic attack [TIA; n = 52], and stroke [n = 55]) from asymptomatic plaques (n = 51). We performed 3 case-control studies (1/symptom with asymptomatic plaques as control). On logistic regression, AmF was independently associated with severity of stenosis, percentage of pixels with gray levels 0 to 10 (PPCS1; measure of echolucency), and spatial gray level dependence matrices (SGLDM) information measure of correlation (IMC-1; texture); TIAs with PPCS1 (echolucency), SGLDM correlation, and skewness (both texture); and stroke with PPCS1, SGLDM correlation, and percentage of pixels with gray levels 11 to 20 (PPCS2; echolucency). The area under the curve of the regression-derived predicted probability for AmF, TIA, and stroke was 0.92, 0.82, and 0.85, respectively (all P < .001). Texture analysis can identify carotid plaques associated with a neurological event, improving the diagnostic value of echolucency measures. Texture analyses could be applied to natural history studies. [ABSTRACT FROM PUBLISHER]

The management of asymptomatic carotid artery stenosis (CAS) has been the subject of extensive debate. Current evidence suggests that the annual risk of stroke in patients with CAS and without previous cerebrovascular symptoms is 1% which makes carotid endarterectomy unjustifiable. Conservative treatment with statins and antiplatelets, the identification of the high risk individuals as well as aggressive life style modifications are considered sufficient measures for the protection of these patients. However, there are reasons to believe that this approach may be less effective than we think. Best medical treatment is only effective when compliance is adequate and lipid or blood pressure target levels are achieved. However this is not always the case and the same applies regarding life style modification changes such as smoking. In addition, there is no consensus regarding the identification of the high risk individuals despite recent encouraging evidence. The introduction of a structured network of risk factor modification clinics in conjunction with the vascular clinics and the identification of ways to objectively risk-stratify patients with asymptomatic CAS could enable us to optimize the management of these patients when we decide to be less radical. [ABSTRACT FROM PUBLISHER]