Vol 8, No 1 (2006)
Published online: 2006-03-17
The correlation between the duration of neurological symptoms among patients with carotid disease and unstable carotid plaque features
Chirurgia Polska 2006;8(1):73-83.
Abstract
Background: Our hypothesis was that symptomatic patients may have carotid plaques differing in morphology
and therefore are more vulnerable to ME than those which are asymptomatic. We also wanted to
test the hypothesis that symptomatic patients who had presented no recent symptoms (on-going prior to
surgery) may have a lower risk of perioperative ME than those who are symptomatic and who had presented
on-going symptoms just prior to surgery.
The aim of the study was to assess whether patients with carotid stenosis scheduled for surgery (asymptomatic and symptomatic, both with on-going and no recent symptoms prior to surgery) may differ by: plaque morphology, the rate of ME and the rate of complications.
Material and methods: 116 patients (81 men and 32 women) were evaluated. Among the examined, 3 groups of patients were differentiated according to the presence or duration of neurological symptoms prior to surgery. There were 41 asymptomatic patients, 54 symptomatic, but with no recent symptoms and 21 symptomatic with symptoms on-going prior to carotid surgery. All patients were evaluated regarding the incidence of microembolism, perioperative complications and carotid plaque morphology (assessed by US). The statistical tools applied were the Kruskal-Wallis and Fischer’s exact tests.
Results: The degree of microembolism was significantly higher among the group of patients with symptoms on-going prior to carotid surgery (p = 0.0001 against the other two groups, which did not differ from each other - p = NS). A plaque texture analysis showed that the plaques among patients with symptoms on-going prior to carotid surgery had a significantly higher content of hipoechogenic tissues (typical for unstable lesions) at p = 0.0001 to p = 0.0012 against the other two groups.
Conclusions: The rate of perioperative microembolism may differ among patients with or without recent neurological symptoms. Ultrasound plaque morphology of patients with on-going symptoms prior to surgery is more strongly associated with the likelihood of an unstable plaque. Further research regarding the definition and diagnosis of symptomatic (duration of symptoms prior to surgery) and asymptomatic patients is probably required.
The aim of the study was to assess whether patients with carotid stenosis scheduled for surgery (asymptomatic and symptomatic, both with on-going and no recent symptoms prior to surgery) may differ by: plaque morphology, the rate of ME and the rate of complications.
Material and methods: 116 patients (81 men and 32 women) were evaluated. Among the examined, 3 groups of patients were differentiated according to the presence or duration of neurological symptoms prior to surgery. There were 41 asymptomatic patients, 54 symptomatic, but with no recent symptoms and 21 symptomatic with symptoms on-going prior to carotid surgery. All patients were evaluated regarding the incidence of microembolism, perioperative complications and carotid plaque morphology (assessed by US). The statistical tools applied were the Kruskal-Wallis and Fischer’s exact tests.
Results: The degree of microembolism was significantly higher among the group of patients with symptoms on-going prior to carotid surgery (p = 0.0001 against the other two groups, which did not differ from each other - p = NS). A plaque texture analysis showed that the plaques among patients with symptoms on-going prior to carotid surgery had a significantly higher content of hipoechogenic tissues (typical for unstable lesions) at p = 0.0001 to p = 0.0012 against the other two groups.
Conclusions: The rate of perioperative microembolism may differ among patients with or without recent neurological symptoms. Ultrasound plaque morphology of patients with on-going symptoms prior to surgery is more strongly associated with the likelihood of an unstable plaque. Further research regarding the definition and diagnosis of symptomatic (duration of symptoms prior to surgery) and asymptomatic patients is probably required.
Keywords: carotid plaqueultrasonographyGSM analysismicroembolism
