Key result
Vascularization was significantly increased in the upstream regions of early carotid plaques (30% vs. 23%) and advanced atherosclerotic lesions (4.6 vs. 1.4 vessels/mm2) compared with downstream regions.
Why the study?
Is vascularization increased in the upstream regions compared to downstream regions of early and advanced human carotid atherosclerotic plaques?
Cross-Sectional (n=101)
Single-blind
No
Is vascularization increased in the upstream regions compared to downstream regions of early and advanced human carotid atherosclerotic plaques?
Vascularization is significantly higher in the upstream regions of both early and advanced carotid atherosclerotic plaques, suggesting a localized vulnerability driven by inflammation.
Suggests upstream carotid plaque vulnerability; hypothesis-generating and requires prospective validation before clinical consideration.
BACKGROUND: Vascularization of atherosclerotic plaques has been linked to plaque vulnerability. The aim of this study was to test if the vascularization was increased in upstream regions of early atherosclerotic carotid plaques and also to test if the same pattern of vascularization was seen in complicated, symptomatic plaques. METHODS: We enrolled 45 subjects with early atherosclerotic lesions for contrast enhanced ultrasound and evaluated the percentage of plaque area in a longitudinal ultrasound section which contained contrast agent. Contrast-agent uptake was evaluated in both the upstream and downstream regions of the plaque. We also collected carotid endarterectomy specimens from 56 subjects and upstream and downstream regions were localized using magnetic resonance angiography and analyzed using histopathology and immunohistochemistry. RESULTS: Vascularization was increased in the upstream regions of early carotid plaques compared with downstream regions (30% vs. 23%, p = 0.033). Vascularization was also increased in the upstream regions of advanced atherosclerotic lesions compared with downstream regions (4.6 vs. 1.4 vessels/mm2, p = 0.001) and was associated with intra-plaque hemorrhage and inflammation. CONCLUSIONS: Vascularization is increased in the upstream regions of both early and advanced plaques and is in advanced lesions mainly driven by inflammation.
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Hjelmgren et al. (2016) conducted a cross-sectional in Carotid atherosclerosis (n=101). Upstream region of carotid plaque vs. Downstream region of carotid plaque was evaluated on Vascularization (percentage of plaque area containing contrast agent in early plaques) (p=0.033). Vascularization was significantly increased in the upstream regions of early carotid plaques (30% vs. 23%) and advanced atherosclerotic lesions (4.6 vs. 1.4 vessels/mm2) compared with downstream regions.
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