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(Stroke. 2001;32:719.)
© 2001 American Heart Association, Inc.

Original Contributions

¹¹¹In Platelet Scintigraphy for the Noninvasive Detection of Carotid Plaque Thrombosis

Giampiero Manca, MD; Giuliano Parenti, MD; Riccardo Bellina, MD; Giuseppe Boni, MD; Mariano Grosso; Walter Bernini; Carlo Palombo, MD; Marco Paterni, DEng; Gualtiero Pelosi, MD; Maria Lanza, MD; Nicola Mazzuca, MD; Romano Bianchi, MD Raffaele De Caterina, MD, PhD

From the Divisions of Nuclear Medicine (G.M., R.B., G.B., M.G., R.B.) and Hematology (M.L.), University of Pisa, Pisa, Italy; Division of Neurosurgery (G.P.), Spedali Riuniti di Santa Chiara, Pisa, Italy; Division of Nuclear Medicine, Ospedali Civili di Livorno, Livorno, Italy (N.M.); and CNR Institute of Clinical Physiology (W.B., C.P., M.P., G.P., R. De C.), Pisa, Italy.

Correspondence to Raffaele De Caterina, MD, PhD, Chair of Cardiology, "G d’Annunzio" University, Chieti, and CNR Institute of Clinical Physiology, Area della Ricerca di S Cataldo, Via Alfieri, 1, I-56100 Pisa, Italy. E-mail rdecater{at}ifc.pi.cnr.it

Background and Purpose—Thrombosis on atherosclerotic lesions in the large extracranial arteries is the main cause of embolization in the distal cerebral circulation and thus is involved in the pathogenesis of ischemic stroke. The assessment of biological characteristics of lesions that are predictive of thrombotic complications might help in stratification of the risk for stroke but is currently imperfect.

Methods—We compared the performance of ¹¹¹In-platelet scintigraphy with blood pool subtraction, ultrasound-based tissue texture analyses, and transcranial Doppler techniques in their ability to predict the occurrence of superficial thrombosis or the presence of a lipid pool in carotid artery plaque specimens removed at the time of carotid endarterectomy in 22 patients with unilateral carotid artery stenosis of >70%.

Results—Positivity at ¹¹¹In-platelet scintigraphy was present in 8 patients and correctly identified the presence of thrombosis superimposed on a complicated plaque. Neither tissue texture analysis nor emboli detection by transcranial Doppler, performed in 12 patients, significantly identified plaque thrombosis. None of the techniques used were able to detect the presence of a significant lipid pool inside the plaque.

Conclusions—Indium-platelet scintigraphy is an accurate noninvasive diagnostic tool to detect thrombotic complications in carotid plaques. Prospective studies should assess its ultimate value in risk stratification, possibly to guide the decision of whether to perform endarterectomy in selected patient categories.

Key Words: atherosclerosis • carotid stenosis • platelets • stroke assessment • thrombosis

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