Pre-operative carotid plaque echolucency assessment has no predictive value for long-term risk of stroke or cardiovascular death in patients undergoing carotid endarterectomy

Introduction In patients with carotid stenosis receiving medical treatment, carotid plaque echolucency has been thought to predict risk of future stroke and of other cardiovascular events. In this study we evaluated the prognostic value of preoperative plaque echolucency for future stroke and cardiovascular death in patients undergoing carotid endarterectomy in the first Asymptomatic Carotid Surgery Trial (ACST-1). Methods In ACST-1, 1832/3120 patients underwent carotid endarterectomy (CEA) of whom 894 had visual echolucency assessment according to the Gray-Weale classification. During follow-up patients were monitored both for peri-procedural (ie, within 30 days) death, stroke or MI and for long-term risk of stroke or cardiovascular death. Unconditional maximum likelihood estimation was used to calculate odds ratios of peri-procedural risk and Kaplan-Meier statistics with log-rank test were used to compare cumulative long term risks. Results Of 894 operated patients in whom echolucency was assessed, 458 plaques (51%) were rated as echolucent and peri-procedural risk of death/stroke/MI in these patients was non-significantly higher when compared to patients with non-echolucent plaques (OR=1.48 [95% CI = 0.76 – 2.88], p=0.241). We found no differences in10-year risk of any stroke (30/447 [11.6%] vs 29/433 [11.0%], p=0.900) or cardiovascular (non-stroke) death (85/447 [27.9%] vs 93/433 [32.1%], p=0.301). Conclusion In ACST-1, carotid plaque echolucency assessment in patients undergoing CEA offered no predictive value with regard to perioperative or long-term stroke risk or of cardiovascular (non-stroke) death.