Angiogenesis in Carotid Atherosclerotic Lesions Is Associated with Timing of Ischemic Neurological Events and Presence of Computed Tomographic Cerebral Infarction in the Ipsilateral Cerebral Hemisphere

We studied the association between plaque vascularity, timing of neurological and ocular symptoms, and presence of cerebral infarction in the ipsilateral cerebral hemisphere on preoperative computed tomographic (CT) scan. Consecutive patients undergoing carotid endarterectomy for carotid stenosis were included. All patients underwent preoperative noncontrast cerebral CT. Histological sections were obtained from carotid endarterectomy specimens and stained with an endothelial cell marker (CD34). Microvessel counts were performed in CD34-stained sections and verified through computerized image analysis. Associations between microvessel density in carotid atherosclerotic plaques, preoperative ipsilateral CT evidence of cerebral infarction, and timing of ipsilateral neurological and ocular events were assessed. Seventy-three patients underwent carotid endarterectomy, of whom 17 were symptomatic within 30 days of carotid endarterectomy, 11 were asymptomatic, and a further 45 had a preoperative symptom-free interval of 31-540 days (median = 56). Eighteen patients (24.6%) had CT evidence of cerebral infarction. Significantly higher microvessel counts were observed in patients with CT evidence of cerebral infarction in the appropriate hemisphere compared with patients who did not (p = 0.02). There was an inverse relationship between the microvessel density in atherosclerotic lesions and the timing of ischemic neurological events (odds ratio [OR] = 4.63, 95% confidence interval [CI] 2.95-7.28, p < 0.001). This relationship was independent of patient age (OR = 1.03, 95% CI 0.55-1.99, p = 0.70), sex (OR = 1.18, 95% CI 0.47-2.05, p = 0.56), smoking (OR = 1.07, 95% CI 0.54-2.09, p = 0.84), diabetes (OR = 0.90, 95% CI 0.45-1.79, p = 0.76), and hypercholesterolemia (OR = 0.98, 95% CI 0.68-1.11, p = 0.88). This study confirms the relationship between angiogenesis in carotid atherosclerotic lesions and development and chronology of ipsilateral hemispheric neurological events.