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(Stroke. 2005;36:257.)
© 2005 American Heart Association, Inc.

Original Contributions

Editorial Comment—Plaque Pathology and Patient Selection for Carotid Endarterectomy

J. Max Findlay, MD, PhD, FRCSC

Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Edmonton, Alberta

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Experienced carotid surgeons know that when performing a carotid endarterectomy, it is important to avoid excessive manipulation of the carotid bifurcation during dissection, especially when the patient has had recent symptoms from an "active" plaque. This study by Fisher et al comparing the pathology of carotid plaques obtained from the asymptomatic carotid endarterectomy trial, ACAS, to those taken from the symptomatic trial, NASCET, helps explain the danger. Plaques resected from symptomatic patients are more frequently ulcerated and have attached thrombus compared with asymptomatic plaques and, therefore, are at greater risk to embolize clot and atherosclerotic debris into the cerebral circulation during surgical mobilization. During carotid endarterectomy, the tube-like carotid plaque is cut length-wise and not infrequently torn, preventing a highly accurate gross or microscopic assessment. This might explain why the associations between ulcers, thrombus, and ipsilateral symptoms were not found to be even stronger. In the study reported here, ulceration has a similar frequency in either carotid of a patient with unilateral symptoms, and thrombus was relatively common in plaques not causing symptoms, being present in 21% of plaques in which the symptoms were from the contralateral carotid and 18% of asymptomatic patients. Trends detected in this study (not reaching statistical significance) included the greater prevalence of plaque thrombus when symptoms were closer to the time of surgery (29% for symptoms 30 days versus 19% for symptoms >30 days from surgery) and the greater prevalence of thrombus in those symptomatic patients with stroke (35%) than those with transient ischemic attack . . . [Full Text of this Article]

Related Article:

Carotid Plaque Pathology: Thrombosis, Ulceration, and Stroke Pathogenesis

Mark Fisher, Annlia Paganini-Hill, Aldana Martin, Michele Cosgrove, James F. Toole, Henry J.M. Barnett, and John Norris
Stroke 2005 36: 253-257. [Abstract] [Full Text] [PDF]