Ultrasound assessment of carotid plaque structure

Recent clinicopathological studies have demonstrated that histologically, inhomogeneous plaques with ulcerated surfaces located at the internal carotid artery origin play an important etiological role in symptomatic carotid artery diseases. We compared in a prospective study duplex-ultrasound characteristics of symptomatic ICA stenoses with cranial computed tomographic (CCT) findings in 82 patients suffering from middle cerebral artery symptoms. According to their ultrasonic feature we characterized the ICA plaque surface as smooth or irregular and their structure as homogeneous or inhomogeneous. As a result, plaques with irregular surface and an inhomogeneous echogenicity dominated significantly in embolic CCT-territory infarctions (p < 0.01), whereas hemodynamically induced infarctions showed no correlation to any plaque characteristic. Normal CCT and lacunar infarctions were correlated to homogenous and smooth plaques (both p < 0.05). Recently developed new ultrasound techniques like power Doppler and computerized 3-D reconstruction improve the ability to diagnose clinical relevant plaque ulcerations.