Vulnerable plaques in the contralateral carotid arteries in symptomatic patients: A detailed ultrasound analysis

•We compared carotid plaque features in three groups of arteries: symptomatic, asymptomatic and contralateral.•Contralateral arteries have features similar to symptomatic arteries.•Contralateral arteries have more vulnerable textural and morphological features compared to asymptomatic arteries.•These findings support the concept of generalized carotid atherosclerotic pathology that needs aggressive control.

Background and aimCarotid plaques may represent a generalized atherosclerotic syndrome or a localized disease. The aim of this study was to assess the morphological and textural features of carotid plaques located contralateral to the symptomatic side and compare them with the symptomatic side and with plaques from asymptomatic patients.MethodsWe studied 66 arteries in 39 patients (mean age 70 ± 7 year, 33% females). Arterial plaques were classified as either symptomatic (n = 30), contralateral to symptomatic (n = 25) or asymptomatic (n = 11). We compared several plaque features between these groups including the mean values of the grey scale median (GSM), entropy, juxtaluminal black area (JBA) without visible echogenic cap, GSM of the JBA and surface irregularity.ResultsThe plaques contralateral to symptomatic arteries had similar morphological and textural features to those in the symptomatic arteries. In contrast, they had more vulnerable morphological and textural features than those in asymptomatic arteries: less smooth plaques (12% vs. 55%) and instead more often mildly irregular (60% vs 36%) or markedly irregular (28% vs. 9%; p = 0.03), lower GSM (26.2 ± 8 vs. 49.4 ± 14, p < 0.001) and lower GSM of the JBA (5.0 ± 3.6 vs. 11.4 ± 2.1, p = 0.008). The frequency of entropy and plaque calcification was similar in all groups.ConclusionSymptomatic patients with carotid artery disease seem to have similar morphological and textural features of vulnerability in the symptomatic and the contralateral carotid arteries, which are profound compared with asymptomatic carotid arteries. These findings support the concept of generalized carotid atherosclerotic pathology rather than incidental unilateral disease, and also emphasize a need for aggressive measures for plaque stabilization, particularly in symptomatic patients.

Graphical abstractDifferences in grey scale median (GSM) and surface plaque irregularities between asymptomatic, contralateral to symptomatic and symptomatic arteries.Download high-res image (112KB)Download full-size image