The purpose of the study was to investigate the association between Ischemic stroke and the ultrasonographic (US) characterization of carotid plaque on the basis of our original work and of a review of the literature.
Carotid plaque is known to be a reliable marker of Ischemic stroke and systemic atherosclerosis. There is much evidence from secondary prevention trials to indicate a direct relationship between the surface and internal US characterization of carotid plaque and stroke. Moreover, in the primary prevention of stroke, the Cardiovascular Health Study showed that the risk of incident stroke was associated with two US features, hypoechoic internal carotid arterial plaque and an estimated internal carotid arterial stenosis of 50%-100%, in asymptomatic adults aged 65 years. However, many studies that have compared the morphologic features of carotid plaque as revealed by both US studies and histology have shown a relatively low rate of detection of important features such as intraplaque hemorrhage. Furthermore, although severe carotid stenosis is associated with a higher risk of stroke events, the power of US to predict such events is limited by low incidence rates and low rate of progression.
We conclude that US plaque characterization should be used together with other risk factors in prospective natural history studies that aim to identify a subgroup of patients at high risk of stroke.
