Unstable Carotid Plaque is Associated With Coagulation Function and Platelet Activity Evaluated by Thrombelastography

Background: Rupture of unstable carotid plaque and consequently occlusive thrombus formation for the most part cause ischemic cerebral vascular event. Many researchers have been studying on the risk predictors of carotid plaque formation. But the risk factors for unstable carotid plaque have not been researched for so much. In the current study, we aimed to evaluate the association of coagulation function and carotid plaque especially unstable plaque by thrombelastography (TEG). Methods: This was a cross-sectional study. Consecutive eligible patients with acute ischemic stroke were included and their TEG data were collected. Carotid plaque was evaluated by carotid ultrasound. Echolucent plaque and heterogeneous echo plaque in ultrasound were classified as unstable carotid plaque. Patients were classified according to being with carotid plaque or unstable plaque for comparison. Results: Four hundred and seven patients were enrolled. Compared to those without carotid plaques, patients with carotid plaques had higher ages, higher incidence of hypertension and diabetes mellitus, lower kappa (P=.017) and higher angle (P=.021) on TEG. In the comparison between groups with unstable plaque and stable plaque, no significant difference was found in baseline characteristics; higher serum fibrinogen and higher maximum amplitude on TEG were significantly correlated to unstable carotid plaques (P=.051, P=.009). Multivariate logistic analysis revealed that age, hypertension, and smoking were independent risk factors of carotid plaques formation; higher serum fibrinogen was an independent risk factor of unstable plaques formation. Conclusions: This study demonstrates that carotid plaques formation in ischemic stroke patients has a link to abnormal coagulation function, while high platelet activity has an additional contribution to unstable plaque formation.