Advertisement

The Unstable Carotid Plaque

  • Salim Habib
    Affiliations
    Department of Vascular Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA

    Division of Vascular Surgery, Department of Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA 15143, USA
    Search for articles by this author
  • Muhammad Saad Hafeez
    Affiliations
    Department of Vascular Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA

    Division of Vascular Surgery, Department of Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA 15143, USA
    Search for articles by this author
  • Theodore H. Yuo
    Affiliations
    Division of Vascular Surgery, Department of Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA 15143, USA
    Search for articles by this author
  • Kathirvel Subramaniam
    Correspondence
    Corresponding author.
    Affiliations
    Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, 3471 5th Avenue Ste 402, Pittsburgh, PA 15213, USA
    Search for articles by this author
Published:October 07, 2022DOI:https://doi.org/10.1016/j.anclin.2022.08.015

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.

      Subscribe:

      Subscribe to Anesthesiology Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Virani S.S.
        • Alonso A.
        • Benjamin E.J.
        • et al.
        Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association.
        Circulation. 2020; 141: e139-e596
        • Naylor A.R.
        Why is the management of asymptomatic carotid disease so controversial?.
        Surgeon. 2015; 13 (In en): 34-43
        • Ferguson G.G.
        • Eliasziw M.
        • Barr H.W.
        • et al.
        The North American Symptomatic Carotid Endarterectomy Trial : surgical results in 1415 patients.
        Stroke. 1999; 30 (In eng): 1751-1758
        • AbuRahma A.F.
        • Avgerinos E.
        • Chang R.W.
        • et al.
        SOCIETY FOR VASCULAR SURGERY CLINICAL PRACTICE GUIDELINES FOR MANAGEMENT OF EXTRACRANIAL CEREBROVASCULAR DISEASE.
        J Vasc Surg. 2021; 0 (In English)
        • Naylor A.R.
        • Ricco J.B.
        • de Borst G.J.
        • et al.
        Editor's Choice - Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS).
        Eur J Vasc Endovasc Surg. 2018; 55 (In eng): 3-81
        • Walker M.D.
        • Marler J.R.
        • Goldstein M.
        • et al.
        Endarterectomy for Asymptomatic Carotid Artery Stenosis.
        JAMA. 1995; 273: 1421-1428
        • Skagen K.
        • Skjelland M.
        • Zamani M.
        • et al.
        Unstable carotid artery plaque: new insights and controversies in diagnostics and treatment.
        Croat Med J. 2016; 57 (In eng): 311-320
        • Abbott A.L.
        • Brunser A.M.
        • Giannoukas A.
        • et al.
        Misconceptions regarding the adequacy of best medical intervention alone for asymptomatic carotid stenosis.
        J Vasc Surg. 2020; 71 (In eng): 257-269
        • de Weerd M.
        • Greving J.P.
        • Hedblad B.
        • et al.
        Prevalence of asymptomatic carotid artery stenosis in the general population: an individual participant data meta-analysis.
        Stroke. 2010; 41 (In eng): 1294-1297
        • Huibers A.
        • de Borst G.J.
        • Bulbulia R.
        • et al.
        Plaque Echolucency and the Risk of Ischaemic Stroke in Patients with Asymptomatic Carotid Stenosis Within the First Asymptomatic Carotid Surgery Trial (ACST-1).
        Eur J Vasc Endovasc Surg. 2016; 51 (In eng): 616-621
        • Larson A.S.
        • Brinjikji W.
        • Savastano L.E.
        • et al.
        Carotid Intraplaque Hemorrhage Is Associated with Cardiovascular Risk Factors.
        Cerebrovasc Dis (Basel, Switzerland). 2020; 49 (In eng): 355-360
        • Singh N.
        • Moody A.R.
        • Gladstone D.J.
        • et al.
        Moderate carotid artery stenosis: MR imaging-depicted intraplaque hemorrhage predicts risk of cerebrovascular ischemic events in asymptomatic men.
        Radiology. 2009; 252 (In eng): 502-508
        • Mathiesen E.B.
        • Bønaa K.H.
        • Joakimsen O.
        Echolucent plaques are associated with high risk of ischemic cerebrovascular events in carotid stenosis: the tromsø study.
        Circulation. 2001; 103 (In eng): 2171-2175
        • Avgerinos E.D.
        • Kadoglou N.P.
        • Moulakakis K.G.
        • et al.
        Current role of biomarkers in carotid disease: a systematic review.
        Int J Stroke. 2011; 6 (In eng): 337-345
        • Riccioni G.
        • Vitulano N.
        • Mancini B.
        • et al.
        One-year treatment with rosuvastatin reduces intima-media thickness in 45 hypercholesterolemic subjects with asymptomatic carotid artery disease.
        Pharmacology. 2010; 85 (In eng): 63-67
        • Silver A.E.
        • Vita J.A.
        Shear-stress-mediated arterial remodeling in atherosclerosis: too much of a good thing?.
        Circulation. 2006; 113: 2787-2789
        • Resnick N.
        • Yahav H.
        • Shay-Salit A.
        • et al.
        Fluid shear stress and the vascular endothelium: for better and for worse.
        Prog Biophys Mol Biol. 2003; 81: 177-199
        • Bobryshev Y.V.
        • Ivanova E.A.
        • Chistiakov D.A.
        • et al.
        Macrophages and Their Role in Atherosclerosis: Pathophysiology and Transcriptome Analysis.
        Biomed Res Int. 2016; 2016: 9582430
        • Seimon T.
        • Tabas I.
        Mechanisms and consequences of macrophage apoptosis in atherosclerosis.
        J Lipid Res. 2009; 50: S382-S387
        • Migdalski A.
        • Jawien A.
        New insight into biology, molecular diagnostics and treatment options of unstable carotid atherosclerotic plaque: a narrative review.
        Ann Transl Med. 2021; 9: 1207
        • Hansson G.K.
        Inflammation, atherosclerosis, and coronary artery disease.
        N Engl J Med. 2005; 352: 1685-1695
        • Spagnoli L.G.
        • Bonanno E.
        • Sangiorgi G.
        • et al.
        Role of inflammation in atherosclerosis.
        J Nucl Med. 2007; 48 (In eng): 1800-1815
        • Silvestre-Roig C.
        • de Winther M.P.
        • Weber C.
        • et al.
        Atherosclerotic plaque destabilization: mechanisms, models, and therapeutic strategies.
        Circ Res. 2014; 114 (In eng): 214-226
        • McCarthy M.J.
        • Loftus I.M.
        • Thompson M.M.
        • et al.
        Angiogenesis and the atherosclerotic carotid plaque: an association between symptomatology and plaque morphology.
        J Vasc Surg. 1999; 30 (In eng): 261-268
        • Mofidi R.
        • Crotty T.B.
        • McCarthy P.
        • et al.
        Association between plaque instability, angiogenesis and symptomatic carotid occlusive disease.
        Br J Surg. 2001; 88 (In eng): 945-950
        • Giannoni M.F.
        • Vicenzini E.
        Focus on the "unstable" carotid plaque: detection of intraplaque angiogenesis with contrast ultrasound. Present state and future perspectives.
        Curr Vasc Pharmacol. 2009; 7 (In eng): 180-184
        • Wijeratne T.
        • Menon R.
        • Sales C.
        • et al.
        Carotid artery stenosis and inflammatory biomarkers: the role of inflammation-induced immunological responses affecting the vascular systems.
        Ann Transl Med. 2020; 8 (In eng): 1276
        • Halvorsen B.
        • Otterdal K.
        • Dahl T.B.
        • et al.
        Atherosclerotic plaque stability--what determines the fate of a plaque?.
        Prog Cardiovasc Dis. 2008; 51 (In eng): 183-194
        • Owens 3rd, A.P.
        • Mackman N.
        Role of tissue factor in atherothrombosis.
        Curr Atheroscler Rep. 2012; 14 (In eng): 394-401
      1. Moore WS. Moore's Vascular and Endovascular Surgery, Ninth Edition - Chapter 19 Extracranial Cerebrovascular Disease: The Carotid Artery. Ninth ed.

        • Gupta A.
        • Chazen J.L.
        • Hartman M.
        • et al.
        Cerebrovascular reserve and stroke risk in patients with carotid stenosis or occlusion: a systematic review and meta-analysis.
        Stroke. 2012; 43 (In eng): 2884-2891
        • Pickett C.A.
        • Jackson J.L.
        • Hemann B.A.
        • et al.
        Carotid bruits and cerebrovascular disease risk: a meta-analysis.
        Stroke. 2010; 41 (In eng): 2295-2302
        • Jashari F.
        • Ibrahimi P.
        • Bajraktari G.
        • et al.
        Carotid plaque echogenicity predicts cerebrovascular symptoms: a systematic review and meta-analysis.
        Eur J Neurol. 2016; 23 (In eng): 1241-1247
        • Moore W.S.
        • Boren C.
        • Malone J.M.
        • et al.
        Natural history of nonstenotic, asymptomatic ulcerative lesions of the carotid artery.
        Arch Surg. 1978; 113 (In eng): 1352-1359
        • Topakian R.
        • King A.
        • Kwon S.U.
        • et al.
        Ultrasonic plaque echolucency and emboli signals predict stroke in asymptomatic carotid stenosis.
        Neurology. 2011; 77 (In eng): 751-758
        • Nicolaides A.N.
        • Kakkos S.K.
        • Griffin M.
        • et al.
        Effect of image normalization on carotid plaque classification and the risk of ipsilateral hemispheric ischemic events: results from the asymptomatic carotid stenosis and risk of stroke study.
        Vascular. 2005; 13 (In eng): 211-221
        • Kakkos S.K.
        • Griffin M.B.
        • Nicolaides A.N.
        • et al.
        The size of juxtaluminal hypoechoic area in ultrasound images of asymptomatic carotid plaques predicts the occurrence of stroke.
        J Vasc Surg. 2013; 57 ([discussion: 617–8]. [in English]): 609-618.e1
        • Griffin M.B.
        • Kyriacou E.
        • Pattichis C.
        • et al.
        Juxtaluminal hypoechoic area in ultrasonic images of carotid plaques and hemispheric symptoms.
        J Vasc Surg. 2010; 52 (In eng): 69-76
        • Bassiouny H.S.
        • Sakaguchi Y.
        • Mikucki S.A.
        • et al.
        Juxtalumenal location of plaque necrosis and neoformation in symptomatic carotid stenosis.
        J Vasc Surg. 1997; 26 (In eng): 585-594
        • Lal B.K.
        • Hobson R.W.
        • Hameed M.
        • et al.
        Noninvasive identification of the unstable carotid plaque.
        Ann Vasc Surg. 2006; 20 (In eng): 167-174
        • Kitamura A.
        • Iso H.
        • Imano H.
        • et al.
        Carotid Intima-Media Thickness and Plaque Characteristics as a Risk Factor for Stroke in Japanese Elderly Men.
        Stroke. 2004; 35: 2788-2794
        • Madani A.
        • Beletsky V.
        • Tamayo A.
        • et al.
        High-risk asymptomatic carotid stenosis: ulceration on 3D ultrasound vs TCD microemboli.
        Neurology. 2011; 77 (In eng): 744-750
        • Spence J.D.
        Transcranial Doppler monitoring for microemboli: a marker of a high-risk carotid plaque.
        Semin Vasc Surg. 2017; 30 (In eng): 62-66
        • Kakkos S.K.
        • Nicolaides A.N.
        • Charalambous I.
        • et al.
        Predictors and clinical significance of progression or regression of asymptomatic carotid stenosis.
        J Vasc Surg. 2014; 59 (In en): 956-967.e1
        • Khot U.N.
        • Khot M.B.
        • Bajzer C.T.
        • et al.
        Prevalence of conventional risk factors in patients with coronary heart disease.
        JAMA. 2003; 290 (In eng): 898-904
        • Puig N.
        • Jiménez-Xarrié E.
        • Camps-Renom P.
        • et al.
        Search for Reliable Circulating Biomarkers to Predict Carotid Plaque Vulnerability.
        Int J Mol Sci. 2020; 21: 8236
        • Khan T.A.
        • Shah T.
        • Prieto D.
        • et al.
        Apolipoprotein E genotype, cardiovascular biomarkers and risk of stroke: Systematic review and meta-analysis of 14 015 stroke cases and pooled analysis of primary biomarker data from up to 60 883 individuals.
        Int J Epidemiol. 2013; 42: 475-492
        • Tanne D.
        • Benderly M.
        • Goldbourt U.
        • et al.
        C-reactive protein as a predictor of incident ischemic stroke among patients with preexisting cardiovascular disease.
        Stroke. 2006; 37 (In eng): 1720-1724
        • Ridker P.M.
        • MacFadyen J.G.
        • Everett B.M.
        • et al.
        Relationship of C-reactive protein reduction to cardiovascular event reduction following treatment with canakinumab: a secondary analysis from the CANTOS randomised controlled trial.
        Lancet. 2018; 391 (In eng): 319-328
        • Netuka D.
        • Belšán T.
        • Broulíková K.
        • et al.
        Detection of carotid artery stenosis using histological specimens: a comparison of CT angiography, magnetic resonance angiography, digital subtraction angiography and Doppler ultrasonography.
        Acta Neurochir (Wien). 2016; 158 (In eng): 1505-1514
        • Golemati S.
        • Patelaki E.
        • Gastounioti A.
        • et al.
        Motion synchronisation patterns of the carotid atheromatous plaque from B-mode ultrasound.
        Sci Rep. 2020; 10 (In eng)11221
        • Lee W.
        General principles of carotid Doppler ultrasonography.
        Ultrasonography. 2014; 33 (In eng): 11-17
        • Khan A.A.
        • Koudelka C.
        • Goldstein C.
        • et al.
        Semiautomatic quantification of carotid plaque volume with three-dimensional ultrasound imaging.
        J Vasc Surg. 2017; 65 (In eng): 1407-1417
        • Faggioli G.L.
        • Pini R.
        • Mauro R.
        • et al.
        Identification of Carotid ‘Vulnerable Plaque’ by Contrast-enhanced Ultrasonography: Correlation with Plaque Histology, Symptoms and Cerebral Computed Tomography.
        Eur J Vasc Endovasc Surg. 2011; 41 (In en): 238-248
        • Korcarz C.E.
        • DeCara J.M.
        • Hirsch A.T.
        • et al.
        Ultrasound Detection of Increased Carotid Intima-Media Thickness and Carotid Plaque in an Office Practice Setting: Does It Affect Physician Behavior or Patient Motivation?.
        J Am Soc Echocardiogr. 2008; 21: 1156-1162
        • Brinjikji W.
        • Huston 3rd, J.
        • Rabinstein A.A.
        • et al.
        Contemporary carotid imaging: from degree of stenosis to plaque vulnerability.
        J Neurosurg. 2016; 124 (In eng): 27-42
        • Kleindorfer D.O.
        • Towfighi A.
        • Chaturvedi S.
        • et al.
        2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association.
        Stroke. 2021; 52: e364-e467
        • Woo S.Y.
        • Joh J.H.
        • Han S.A.
        • et al.
        Prevalence and risk factors for atherosclerotic carotid stenosis and plaque: A population-based screening study.
        Medicine (Baltimore). 2017; 96: e5999
        • Taylor D.W.
        • Barnett H.J.
        • Haynes R.B.
        • et al.
        Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: a randomised controlled trial. ASA and Carotid Endarterectomy (ACE) Trial Collaborators.
        Lancet. 1999; 353 (In eng): 2179-2184
        • Hackam D.G.
        • Spence J.D.
        Combining multiple approaches for the secondary prevention of vascular events after stroke: a quantitative modeling study.
        Stroke. 2007; 38: 1881-1885
      2. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST).
        Lancet. 1998; 351 (In eng): 1379-1387
      3. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. European Carotid Surgery Trialists' Collaborative Group.
        Lancet. 1991; 337 (In eng): 1235-1243
        • Barnett H.J.M.
        • Taylor D.W.
        • Eliasziw M.
        • et al.
        Benefit of Carotid Endarterectomy in Patients with Symptomatic Moderate or Severe Stenosis.
        N Engl J Med. 1998; 339: 1415-1425
        • AbuRahma A.F.
        • Avgerinos E.D.
        • Chang R.W.
        • et al.
        The Society for Vascular Surgery implementation document for management of extracranial cerebrovascular disease.
        J Vasc Surg. 2022; 75 (In eng): 26s-98s
        • Paraskevas K.I.
        • Veith F.J.
        • Ricco J.-B.
        Best medical treatment alone may not be adequate for all patients with asymptomatic carotid artery stenosis.
        J Vasc Surg. 2018; 68: 572-575
        • Hennerici M.G.
        The unstable plaque.
        Cerebrovasc Dis. 2004; 17 (In eng): 17-22
        • Brott T.G.
        • Brown Jr., R.D.
        • Meyer F.B.
        • et al.
        Carotid revascularization for prevention of stroke: carotid endarterectomy and carotid artery stenting.
        Mayo Clin Proc. 2004; 79 (In eng): 1197-1208
      4. Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study.
        Jama. 1995; 273 (In eng): 1421-1428
        • Halliday A.
        • Harrison M.
        • Hayter E.
        • et al.
        10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial.
        Lancet. 2010; 376 (In eng): 1074-1084
        • Mufti H.N.
        • Alshaltoni R.S.
        • AlGahtani A.
        • et al.
        Role of Carotid Artery Ultrasound Duplex Prior to Cardiac Surgery in Adults in Predicting Neurocognitive Complications.
        Cureus. 2020; 12 (In eng)e11211
        • Li Y.
        • Jenny D.
        • Castaldo J.
        Cardiac surgery, carotid stenosis, and stroke prevention.
        Hosp Pract (1995). 2010; 38 (In eng): 29-39
        • Morgante A.
        • Di Bartolo M.
        Impact of a carotid stenosis on cardiac surgery: marker more than risk factor.
        G Chir. 2019; 40 (In eng): 381-388
        • Pinto Sousa P.
        • Teixeira G.
        • Gonçalves J.
        • et al.
        Carotid Stenosis in Cardiac Surgery Patients.
        Rev Port Cir Cardiotorac Vasc. 2017; 24 (In eng): 126
        • Das P.
        • Clavijo L.C.
        • Nanjundappa A.
        • et al.
        Revascularization of carotid stenosis before cardiac surgery.
        Expert Rev Cardiovasc Ther. 2008; 6 (In eng): 1393-1396
        • Benesch C.
        • Glance L.G.
        • Derdeyn C.P.
        • et al.
        Perioperative Neurological Evaluation and Management to Lower the Risk of Acute Stroke in Patients Undergoing Noncardiac, Nonneurological Surgery: A Scientific Statement From the American Heart Association/American Stroke Association.
        Circulation. 2021; 143 (In eng): e923-e946
        • Wesselink E.M.
        • Kappen T.H.
        • Torn H.M.
        • et al.
        Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review.
        Br J Anaesth. 2018; 121 (In eng): 706-721
        • Carson J.L.
        • Guyatt G.
        • Heddle N.M.
        • et al.
        Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage.
        Jama. 2016; 316 (In eng): 2025-2035
        • Shmigel'skiĭ A.V.
        • Usachev D.
        • Lukshin V.A.
        • et al.
        [Multimodal neuromonitoring in the early diagnosis of brain ischemia during carotid arterial reconstruction].
        Anesteziol Reanimatol. 2008; (In rus): 16-22
        • Rocha-Neves J.
        • Pereira-Macedo J.
        • Ferreira A.
        • et al.
        Impact of intraoperative neurologic deficits in carotid endarterectomy under regional anesthesia.
        Scand Cardiovasc J. 2021; 55 (In eng): 180-186
        • Powers W.J.
        • Rabinstein A.A.
        • Ackerson T.
        • et al.
        Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.
        Stroke. 2019; 50 (In eng): e344-e418
        • Lehot J.J.
        • Durand P.G.
        [Anesthesia for carotid endarterectomy].
        Rev Esp Anestesiol Reanim. 2001; 48 (In spa): 499-507
        • Yepes Temiño M.J.
        • Lillo Cuevas M.
        [Anesthesia for carotid endarterectomy: a review].
        Rev Esp Anestesiol Reanim. 2011; 58 (In spa): 34-41
        • Schermerhorn M.L.
        • Liang P.
        • Eldrup-Jorgensen J.
        • et al.
        Association of Transcarotid Artery Revascularization vs Transfemoral Carotid Artery Stenting With Stroke or Death Among Patients With Carotid Artery Stenosis.
        Jama. 2019; 322 (In eng): 2313-2322
        • Kwolek C.J.
        • Jaff M.R.
        • Leal J.I.
        • et al.
        Results of the ROADSTER multicenter trial of transcarotid stenting with dynamic flow reversal.
        J Vasc Surg. 2015; 62 (In eng): 1227-1234
        • Kashyap V.S.
        • Schneider P.A.
        • Foteh M.
        • et al.
        Early Outcomes in the ROADSTER 2 Study of Transcarotid Artery Revascularization in Patients With Significant Carotid Artery Disease.
        Stroke. 2020; 51 (In eng): 2620-2629
        • Burton B.N.
        • Finneran Iv J.J.
        • Harris K.K.
        • et al.
        Association of Primary Anesthesia Type with Postoperative Adverse Events After Transcarotid Artery Revascularization.
        J Cardiothorac Vasc Anesth. 2020; 34 (In eng): 136-142
        • Mukherjee D.
        • Collins D.T.
        • Liu C.
        • et al.
        The study of transcarotid artery revascularization under local versus general anesthesia with results from the Society for Vascular Surgery Vascular Quality Initiative.
        Vascular. 2020; 28 (In eng): 784-793
        • Teter K.
        • Rockman C.
        • Lamparello P.
        • et al.
        Risk Factors for and Intraoperative Management of Intolerance to Flow Reversal in TCAR.
        Ann Vasc Surg. 2022; 79 (In eng): 41-45