Patients with Recurrent Ischaemic Events from Carotid Artery Disease have a Large Lipid Core and Low GSM

Salem, M.K.; Sayers, R.D.; Bown, M.J.; West, K.; Moore, D.; Nicolaides, A.; Robinson, T.G.; Naylor, A.R.

doi:10.1016/j.ejvs.2011.11.008

« Previous Next »European Journal of Vascular & Endovascular Surgery
Volume 43, Issue 2 , Pages 147-153, February 2012

Patients with Recurrent Ischaemic Events from Carotid Artery Disease have a Large Lipid Core and Low GSM

M.K. Salem
- Vascular Surgery Group, Department of Cardiovascular Sciences, Robert Kilpatrick Clinical Sciences Building, University of Leicester, LE2 7LX, UK
- Corresponding author. Tel.: +44 116 252 3252; fax: +44 116 252 3179.
R.D. Sayers
- Vascular Surgery Group, Department of Cardiovascular Sciences, Robert Kilpatrick Clinical Sciences Building, University of Leicester, LE2 7LX, UK
M.J. Bown
- Vascular Surgery Group, Department of Cardiovascular Sciences, Robert Kilpatrick Clinical Sciences Building, University of Leicester, LE2 7LX, UK
K. West
- Department of Histopathology, University Hospitals Leicester, Leicester, UK
D. Moore
- Department of Histopathology, University Hospitals Leicester, Leicester, UK
A. Nicolaides
- Department of Vascular Surgery, Imperial College, London, UK
T.G. Robinson
- Ageing and Stroke Medicine, Department of Cardiovascular Sciences, University of Leicester, LE2 7LX, UK
A.R. Naylor
- Vascular Surgery Group, Department of Cardiovascular Sciences, Robert Kilpatrick Clinical Sciences Building, University of Leicester, LE2 7LX, UK

Received 18 September 2011; accepted 8 November 2011. published online 09 December 2011.

Abstract

Objectives

The aim of the current study was to determine whether computerised ultrasound plaque analysis could identify features predictive of an increased risk of early recurrent events after symptom onset.

Methods

Between August 2008 and December 2010, 158 consecutive symptomatic patients undergoing carotid endarterectomy (CEA) had their plaques harvested at CEA and then independently scored for markers of histological plaque instability. Duplex ultrasound images recorded prior to CEA were independently assessed using the Iconsoft software.

Results

One hundred and fifty eight recently symptomatic patients underwent CEA with 118 (75%) undergoing their operation within 14 days of their most recent clinical event. Twenty (12.7%) suffered a recurrent cerebral ischaemic event following admission to the vascular unit and before undergoing CEA. Using multivariate stepwise analysis; lipid core (OR 4.00, 95% CI 1.07 to 14.83, P = 0.042) and a low GSM (OR 6.21, 95% CI 1.86 to 20.4, P = 0.003) were independently associated with recurrent cerebrovascular events.

Conclusion

Within a cohort of patients presenting with recent onset cerebral ischaemic events undergoing CEA, the plaques of patients with recurrent events following admission to hospital had evidence a large lipid core and a low GSM.

Keywords: Carotid plaque, Histology, Ultrasound, GSM