Stroke, Vol 10, 238-245, Copyright © 1979 by American Heart Association
AM Imparato, TS Riles and F Gorstein
Embolization from or decreased flow through cervical carotid and vertebral
arteries causes ischemic stroke syndromes. Specific pathologic findings
were studied in 50 symptomatic patients who underwent 69 carotid
endarterectomies. Detailed analyses of their carotid plaques included
correlations between photographs of gross specimens, microscopic findings,
angiograms, preoperative symptoms and long-term postoperative follow up.
Carotid plaques were primarily fibrous with significant (greater than 70%)
stenoses encountered in 70% of the arteries. Stenoses were due to simple
fibrous thickening in only 20%; the remainder due to intraplaque
hemorrhage, atheromatous debris and, least often, luminal thrombus with or
without ulceration. Intramural hemorrhage was frequent in plaques
associated with focal neurologic symptoms and may have preceded localized
collections of atheromatous debris. Ulceration occurred in 1/3 of all
plaques, symptomatic or not. It is concluded that the carotid plaques start
as fibrointimal thickening evolving to symptomatic stages by the occurrence
of one or more of a number of pathologic changes, intraplaque hemorrhage
being prominent. A single rational therapeutic regimen seems impossible
until patients can be classified according to their pathologic changes
diagnosed non-invasively.
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