Ultrasonographical Features Associated with Progression of Atherosclerosis in Patients with Moderate Internal Carotid Ar
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ORIGINAL ARTICLE
Ultrasonographical Features Associated with Progression of Atherosclerosis in Patients with Moderate Internal Carotid Artery Stenosis Yumei Liu 1 & Yang Hua 1 & Ran Liu 1 & Lili Wang 1 & Chun Duan 1 & Chen Ling 1 & Xiaoguang Wu 2 & Ovbiagele Bruce 3 & Wuwei Feng 3 Received: 10 June 2017 / Revised: 27 October 2017 / Accepted: 20 November 2017 # Springer Science+Business Media, LLC, part of Springer Nature 2017
Abstract Carotid artery stenosis (CAS) is a leading cause of ischemic stroke. Plaque stabilization is a major management approach. Information about the ultrasonographical and clinical features associated with the progression of moderate internal carotid artery (ICA) stenosis (50–69%) could assist with prognostication and risk factor modifications. We evaluated 287 patients with moderate ICA stenosis (50–69%) and subsequently evaluated them at follow-up points at 12, 24, and 36 months. Patients were divided into three groups according to the degree of ICA stenosis: progression (70–99%, n = 48), stable (50–69%, n = 210), and regression (< 50%, n = 29). Responsible plaque thickness (RPT) across groups during follow-up was compared using a repeated measure ANOVA test. An ordinal regression was subsequently applied to identify risk factors for atherosclerosis progression. Male (P = 0.04), hypoechoic plaque (P < 0.01), smoking (P = 0.02), plaque ulceration (P = 0.05), and contralateral severe CAS or occlusions (P = 0.04) on ultrasound was more frequent in the progression group vs. other two groups. The ordinal regression revealed that only hypoechoic plaque (OR, 7.03; 95% CI, 3.34–14.81; P < 0.01) and contralateral ICA severe stenosis or occlusion (OR, 2.86; 95% CI, 1.41–5.80; P < 0.01) were independently associated with stenosis progression, while statin use was inversely associated with stenosis progression (OR, 0.26; 95% CI, 0.13–0.54; P < 0.01). Of note, symptomatic vs. asymptomatic moderate CAS at baseline was not associated with progression. For patients with moderate CAS, hypoechoic plaque, contralateral severe stenosis or occlusion on ultrasonography, and statin use are independently related to stenosis progression. Statin use may delay the progression of carotid stenosis. Keywords Carotid stenosis . Progression . Risk factor . Ultrasonography . Statin
Introduction Stroke is the number one cause of death as well as the number one cause of disability in China [1, 2]. Symptomatic carotid artery stenosis (CAS) is a common etiology of stroke. The results of the Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) study demonstrated that the risk of ipsilateral
* Yang Hua [email protected] 1
Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing 100045, China
2
Evidence-Based Medicine Center, Xuanwu Hospital, Capital Medical University, Beijing 100045, China
3
Department of Neurology, Medical University of South Carolina, Charleston 29425, USA
ischemic events rises as the severity of CAS [3]. Typically, carotid endarterectomy (CEA) is indicated if
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