Carotid Plaque Composition in Chronic Kidney Disease: A Retrospective Analysis of Patients Undergoing Carotid Endarterectomy

Objectives: Calcified plaques are suggested to represent atherosclerotic lesions with stabilising properties. However, patients with chronic kidney disease (CKD) frequently have calcified plaques but significant higher prevalence of cardiovascular complications. The aim of our study was therefore to analyse the effect of CKD in patients with advanced carotid stenosis (>70%) on plaque composition, lesion stability and risk of rupture. Methods: We investigated retrospectively, by histology, carotid plaques of patients with high-grade internal carotid artery stenosis undergoing carotid endarterectomy. Comparison of plaque morphology was performed on 41 patients with CKD with estimated glomerular filtration rate (eGFR) < 60 ml min(-1) (according to the Modification of Diet in Renal Disease formula, MDRD-eGFR) and 56 patients with normal renal function. Results: Patients with CKD had significantly higher percentage of total calcification (17% vs. 7%, p < 0.001), unstable and ruptured plaques (83% vs. 52%, p = 0.001 and 59% vs. 36%, p = 0.039, respectively) compared with patients with normal renal function. By contrast, the content of collagenous fibres was significantly reduced in CKD patients (40% vs. 57%, p = 0.011). No significant differences were found for neurological symptoms and soft plaque content. Conclusion: Our results demonstrate that CKD significantly affects plaque composition in patients with advanced carotid artery stenosis. Enhanced calcification and reduced collagenous plaque may lead to plaque instability and rupture. (C) 2009 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.