Journal of vascular surgery
-
Many studies have linked carotid plaque surface irregularities with stroke risk, but this relationship has been obscured by the limited ability of available imaging modalities to resolve plaque surface morphology. To address this issue, we performed a prospective study correlating the presenting neurologic symptoms of patients with high-resolution magnetic resonance imaging (MRI; 200 microm) studies of ipsilateral plaque surface invaginations and ledges, lumen shape, and the location of the plaque bulk creating the stenosis. ⋯ Surface irregularities were revealed by means of submillimeter resolution of the carotid plaques with MRI to be common, but only the presence of major irregularities correlated with the patient having TIA or stroke. Lumen shape and plaque location did not appear to predict stroke risk, but may effect imaging accuracy in determining the degree of stenosis. These data further define the relationship of plaque irregularity and cerebrovascular symptoms caused by atheroemboli.
-
Post hoc analysis results of the North American Symptomatic Carotid Endarterectomy Trial and the Asymptomatic Carotid Atherosclerosis Study suggest that carotid endarterectomy (CEA) may not be as efficacious in women as it is in men. This study was undertaken for the evaluation of whether there is a difference between men and women in early postoperative outcome after CEA and whether such a difference is consistent across other predictors. ⋯ The combined TIA or stroke and stroke or mortality rates are higher in women as compared with men in the postoperative period, but these risks remain acceptable when CEA is performed for appropriate indications. The interaction between symptoms and gender suggests that, in patients who are asymptomatic, women are more likely than are men to have early complications. However, there is no gender difference in patients who are symptomatic. Therefore, despite a low postoperative complication rate, CEA is appropriate in both women who are asymptomatic and women who are symptomatic only if the postoperative TIA, stroke, and mortality rates are appreciably lower than in the natural history of medical management of these patients.