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Abstract: Introduction: Intraplaque hemorrhage (IPH) is an important determinant of progression and destabilization of atherosclerotic plaque. We recently demonstrated that IPH is an independent predictor of future cardiovascular events after carotid endarterectomy. Thus far, it is unknown whether clinical patient characteristics, such as medication use, are associated with the occurrence of IPH. The purpose of this study was to examine the association of IPH with clinical patient characteristics. Methods and results: 1070 consecutive patients who underwent a carotid (n =794) or femoral (n =276) endarterectomy were included. Endarterectomy specimens were subjected to histopathological examination. IPH was observed in 644/794 (81%) carotid and 175/276 (63%) femoral plaques. Carotid IPH was positively correlated with advanced age (69 years [IQR: 62–75] vs. 65 years [IQR: 57–73]; P =0.002) and coumarin-type anticoagulation use prior to operation (104/116 [90%] with coumarin derivatives vs. 540/678 [80%] without coumarin derivatives; P =0.01). Carotid IPH was less frequently observed in patients that used statins prior to endarterectomy (468/595 [79%] with statin vs. 176/199 [88%] without statin; P =0.002). In multivariate analysis, age, coumarin-type anticoagulation use and statin use were independently correlated with carotid IPH. No association was observed between femoral IPH and clinical patient characteristics. Conclusion: Advanced age and coumarin-type anticoagulation use are associated with the occurrence of IPH, while statin use is associated with less IPH. [ABSTRACT FROM AUTHOR]

The article discusses a longitudinal study performed to scrutinize the relationship between atherosclerotic plaque histology and the onset of restenosis subsequent to carotid endarterectomy. Five hundred persons who had a carotid endarterectomy performed on them were evaluated one year later for carotid artery restenosis. After one year 17% of patients had developed restenosis of 50% or more. Investigators concluded that plaque composition can independently predict restenosis following a carotid endarterectomy.