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Ultrasonographical Features Associated with Progression of Atherosclerosis in Patients with Moderate Internal Carotid Artery Stenosis

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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.

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Acknowledgments

We would like to thank Dr. Forrest Lowe for his generous comments on the language contents of this manuscript.

Funding

This study was funded by “The Special Funding for Beijing Capital Health, Research and Development; 2011-2001-02” that was awarded to Dr. Yang Hua.

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Authors and Affiliations

  1. Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing, 100045, China

    Yumei Liu, Yang Hua, Ran Liu, Lili Wang, Chun Duan & Chen Ling

  2. Evidence-Based Medicine Center, Xuanwu Hospital, Capital Medical University, Beijing, 100045, China

    Xiaoguang Wu

  3. Department of Neurology, Medical University of South Carolina, Charleston, 29425, USA

    Ovbiagele Bruce & Wuwei Feng

Authors
  1. Yumei Liu
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  2. Yang Hua
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  3. Ran Liu
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  6. Chen Ling
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Correspondence to Yang Hua.

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Conflict of Interest

Yumei Liu declares no conflict of interest. Yang Hua received research grants from “The Special Funding for Beijing Capital Health, Research and Development; 2011-2001-02”. Ran Liu declares no conflict of interest. Lili Wang declares no conflict of interest. Chun Duan declares no conflict of interest. Chen Ling declares no conflict of interest. Xiaoguang Wu declares no conflict of interest. Ovbiagele Bruce receives research grants from NIH, but has no conflict of interest. Wuwei Feng receives research grants from NIH, but has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Liu, Y., Hua, Y., Liu, R. et al. Ultrasonographical Features Associated with Progression of Atherosclerosis in Patients with Moderate Internal Carotid Artery Stenosis. Transl. Stroke Res. 9, 375–381 (2018). https://doi.org/10.1007/s12975-017-0592-9

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  • DOI: https://doi.org/10.1007/s12975-017-0592-9

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