Critical Cap Thickness and Rupture in Symptomatic Carotid Plaques
- 1 June 2008
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 39 (6), 1722-1729
- https://doi.org/10.1161/strokeaha.107.507988
Abstract
Background and Purpose— Advances in carotid plaque imaging could allow quantification of fibrous cap thickness in vivo. While a cap thickness Methods— We made detailed histological assessments of 526 carotid plaques from consecutive patients undergoing endarterectomy for symptomatic carotid stenosis. The thickness of the fibrous cap at the thinnest and most representative part was measured. Results— Cap thickness could be measured reliably in 428 (81%) plaques. In the ruptured plaques (n=257), the median representative cap thickness was 300 μm (IQR 200 to 500 μm) and the median minimum cap thickness was 150 μm (80 to 210 μm; mean=181 μm), which is much greater than the mean cap thickness of 23 μm at the point of rupture that has been reported for coronary plaques. For nonruptured plaques, the median cap thickness values were 500 μm (300 to 700 μm) and 250 μm (180 to 400 μm), respectively. The optimum cut-offs for discriminating between ruptured and nonruptured plaques were a minimum cap thickness P P P 2 =0.30) and were both independently associated with cap rupture. Conclusions— Critical cap thickness is greater in carotid plaques than coronary plaques. Minimum and representative cap thicknesses were both independently associated with cap rupture. A combination of minimum cap thickness <200 μm and a representative cap thickness <500 μm identified ruptured plaques most reliably. Prospective imaging studies are required to establish whether these cut points predict clinical events in patients with asymptomatic carotid stenosis.This publication has 30 references indexed in Scilit:
- Reproducibility of High-Resolution MRI for the Identification and the Quantification of Carotid Atherosclerotic Plaque ComponentsStroke, 2007
- Response to Letter by Karapanayiotides and DevuystStroke, 2006
- Fibrous Cap Thickness and Stability of Carotid AtheromataStroke, 2006
- Comparison of Symptomatic and Asymptomatic Atherosclerotic Carotid Plaque Features with in Vivo MR ImagingRadiology, 2006
- The role of genetic variants of matrix metalloproteinases in coronary and carotid atherosclerosisJournal of Medical Genetics, 2006
- Carotid Stenosis: Looking Beyond the Lumen With UltrasoundStroke, 2006
- How Critical Is Fibrous Cap Thickness to Carotid Plaque Stability?Stroke, 2006
- Association Between Carotid Plaque Characteristics and Subsequent Ischemic Cerebrovascular EventsStroke, 2006
- Low-Grade Carotid StenosisStroke, 2005
- Promoter Polymorphism in the Endotoxin Receptor (CD14) Is Associated With Increased Carotid Atherosclerosis Only in SmokersStroke, 2003