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(Stroke. 2005;36:253.)
© 2005 American Heart Association, Inc.

Original Contributions

Carotid Plaque Pathology

Thrombosis, Ulceration, and Stroke Pathogenesis

Mark Fisher, MD; Annlia Paganini-Hill, PhD; Aldana Martin, HT, HTL; Michele Cosgrove, MD; James F. Toole, MD; Henry J.M. Barnett, MD John Norris, MD

From the Departments of Neurology (M.F., A.M.), Preventive Medicine (A.P.-H.), and Pathology (M.C.), University of Southern California School of Medicine, Los Angeles, Calif; Wake Forest School of Medicine (J.F.T.), Winston-Salem, NC; The John P. Robarts Research Institute (H.J.M.B.), London, Ontario, Canada; and the Department of Clinical Neuroscience (J.N.), St Georges Hospital Medical School, London, UK.

Correspondence to Dr Mark Fisher, Department of Neurology, University of California Irvine Medical Center, 101 The City Drive South, Building 55, Room 121, Orange, CA 92868. E-mail mfisher{at}uci.edu

Background and Purpose— To determine the relationship between ulceration, thrombus, and calcification of carotid artery atherosclerotic plaques and symptoms of ipsilateral or contralateral stroke.

Methods— We compared microscopic plaque morphology from patients with and without stroke symptoms ipsilateral or contralateral to the plaque. Plaques were characterized for ulceration, thrombus, and calcification. We analyzed plaques from 241 subjects: 170 patients enrolled in the Asymptomatic Carotid Atherosclerosis Study (ACAS) and 71 patients enrolled in the North American Symptomatic Carotid Endarterectomy Trial (NASCET); 128 subjects had no history of stroke symptoms, 80 subjects had ipsilateral symptoms, and 33 had contralateral symptoms.

Results— Plaque ulceration was more common in plaques taken from symptomatic patients than those without symptoms (36% versus 14%; P<0.001); frequency of ulceration was similar for plaques associated with ipsilateral (34%) and contralateral (42%) symptoms. Thrombus was most common in plaques taken from patients with both ipsilateral symptoms and ulceration. The extent of calcification was unassociated with stroke symptoms.

Conclusion— Carotid plaque ulceration and thrombosis are more prevalent in symptomatic patients. Ulceration is more common in symptomatic patients regardless of side of carotid symptoms, whereas thrombus is associated with ipsilateral symptoms and plaque ulceration. Preoperative identification of carotid ulceration and thrombus should lead to greater efficacy of stroke prevention by carotid endarterectomy.

Key Words: atherosclerosis • carotid arteries • stroke

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