Carotid plaque surface echogenicity predicts cerebrovascular events: An Echographic Multicentric Swiss Study

Background and Purpose To determine the prognostic value for ischemic stroke or transitory ischemic attack (TIA) of plaque surface echogenicity alone or combined to degree of stenosis in a Swiss multicenter cohort Methods Patients with >= 60% asymptomatic or >= 50% symptomatic carotid stenosis were included. Grey-scale based colour mapping was obtained of the whole plaque and of its surface defined as the regions between the lumen and respectively 0-0.5, 0-1, 0-1.5, and 0-2 mm of the outer border of the plaque. Red, yellow and green colour represented low, intermediate or high echogenicity. Proportion of red color on surface (PRCS) reflecting low echogenictiy was considered alone or combined to degree of stenosis (Risk index, RI). Results We included 205 asymptomatic and 54 symptomatic patients. During follow-up (median/mean 24/27.7 months) 27 patients experienced stroke or TIA. In the asymptomatic group, RI >= 0.25 and PRCS >= 79% predicted stroke or TIA with a hazard ratio (HR) of respectively 8.7 p = 0.0001 and 10.2 p < 0.0001. In the symptomatic group RI >= 0.25 and PRCS >= 81% predicted stroke or TIA occurrence with a HR of respectively 6.1 p = 0.006 and 8.9 p = 0.001. The best surface parameter was located at 0-0.5mm. Among variables including age, sex, degree of stenosis, stenosis progression, RI, PRCS, grey median scale values and clinical baseline status, only PRCS independently prognosticated stroke (p = 0.005). Conclusion In this pilot study including patients with at least moderate degree of carotid stenosis, PRCS (0-0.5mm) alone or combined to degree of stenosis strongly predicted occurrence of subsequent cerebrovascular events.

Automated summary

This study aimed to determine the prognostic value of plaque surface echogenicity alone or combined with degree of stenosis for ischemic stroke or transitory ischemic attack (TIA). The results showed that a high proportion of low echogenicity on the surface of the plaque was strongly predictive of stroke or TIA occurrence, regardless of the degree of stenosis. These findings can help clinicians assess the risk and take preventive measures for adverse events in patients with carotid stenosis.