Evidence of a topographical link between unstable carotid plaques and luminal stenosis: Can we better stratify asymptomatic patients with significant plaque burden?

摘要

Studies in the coronary circulation of patients with acute coronary syndromes demonstrate that plaque rupture may occur in the presence of low grade stenosis and that the degree of stenosis is a poor predictor of ischemic events [1]. However, much less data are available for the carotid circulation. Similar to the coronary district, rupture and thrombosis of a carotid plaque are key factors in ischemic neurological syndromes [2-4]. The risk for thrombotic and thrombo-embolic complications of a carotid atherosclerotic plaque seems more related to morphological features of plaque instability rather than the degree of stenosis [2]. Nevertheless data from randomized trials of carotid endarterectomy clearly indicate that tight stenoses are much more likely to be subsequently associated with stroke rather than less stenotic lesions [5,6].