Arterial Wall Disease and Stroke Prevention by Julien Bogousslavsky, F. Aichner

By Julien Bogousslavsky, F. Aichner

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Patients with irregular or ulcerated plaques in one or both carotid arteries were more likely to have had a previous myocardial infarction than patients with smooth plaques and were twice as likely to suffer a non-stroke vascular death (mainly due to coronary heart disease) on follow-up (fig. 7). However, there was no difference in the risk of non-vascular death. Interestingly, patients with an irregular or ulcerated plaque in the symptomatic carotid artery were twice as likely as those with smooth plaque to have irregular or ulcerated plaque in the contralateral carotid artery.

More data are required before the echogenicity of carotid plaque can be used to identify individuals at increased risk of stroke. Intraplaque haemorrhage is known to be present in a high proportion of atheromatous plaques in both the carotid and coronary arteries. Large haemorrhages can lead to plaque rupture or to a sudden increase in the degree of lumen narrowing (fig. 8), but there is relatively little evidence that intraplaque haemorrhage is a common cause of ischaemic stroke or that the presence of haemorrhage is associated with an increased risk of stroke.

63 Danesh J, Collins R, Peto R: Chronic infections and coronary heart disease: Is there a link? Lancet 1997;350:430–436. 64 Vallance P, Collier J, Bhagat K: Infection, inflammation and infarction: Does acute endothelial dysfunction provide a link? Lancet 1997;349:1391–1392. 65 Rothwell PM, Villagra R, Gibson R, Donders R, Warlow CP: Evidence of a chronic systemic cause of instability of atherosclerotic plaques. Lancet 2000;355:19–24. 66 Rothwell PM, Gibson R, Fox AJ, Warlow CP, Barnett HJM: Systemic predisposition to carotid plaque surface irregularity and coronary vascular death.

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