Echolucent carotid plaque is associated with restenosis after carotid endarterectomy

Qing Li MD 1 , Beibei Liu MD 1 , Yue Zhao MD 1 , Yumei Liu MD, PhD 1 , Mingjie Gao MD, PhD 1 , Lingyun Jia MD, PhD 1 , Liqun Jiao MD, PhD 2 and Yang Hua MD 1 , 3
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  • 1 Departments of Vascular Ultrasound and
  • 2 Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
  • 3 Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Beijing, China
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OBJECTIVE

The mechanism of carotid endarterectomy (CEA) restenosis remains unclear. Our research aimed to investigate the relationship between the carotid plaque grayscale median (GSM) value and restenosis after CEA.

METHODS

Between January 2010 and January 2018, 1280 consecutive patients underwent CEA at our institution; 32 patients were diagnosed with restenosis by ultrasound at 1 year after CEA. The correlations between plaque GSM, plaque echogenicity, clinical manifestations, shunting, and restenosis were analyzed.

RESULTS

In total, 829 patients were ultimately enrolled; 32 (4%) presented diagnoses of restenosis (mean age 67.3 ± 8.0 years, 81.2% men). The GSM value was lower in the restenosis group (68.1 ± 19.9 vs 59.9 ± 14.7, p = 0.02). After multiple logistic regression analysis, the GSM value was found to be an independent risk factor for restenosis (OR 0.976, 95% CI 0.957–0.995). Shunting was another significant independent risk factor for restenosis (OR 2.39, 95% CI 1.07–5.34). The GSM cutoff value for predicting restenosis was 75 (sensitivity 0.38, specificity 0.84, area under the curve 0.62). We separated the patients into 2 groups by GSM (GSM ≤ 75 and GSM > 75 subgroups). Comparison of the 2 groups indicated that symptomatic manifestation was related to restenosis in the subgroup with GSM ≤ 75, indicating predominantly echolucent plaques, but not in the subgroup with GSM > 75, indicating predominantly echogenic plaques.

CONCLUSIONS

Predominantly echolucent carotid plaques, as measured by GSM, had a higher restenosis risk at 1 year than echogenic plaques.

ABBREVIATIONS AUC = area under the curve; CEA = carotid endarterectomy; DSA = digital subtraction angiography; GSM = grayscale median; ICA = internal carotid artery; nIMT = neointima-media thickness; PSV = peak systolic velocity; ROC = receiver operating characteristic.

Supplementary Materials

    • Supplemental Table 1 (PDF 384 KB)

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Contributor Notes

Correspondence Yang Hua: Xuanwu Hospital, Capital Medical University, Beijing, China. dryanghua99@163.com.

INCLUDE WHEN CITING Published online April 17, 2020; DOI: 10.3171/2020.2.JNS193397.

Q.L. and B.L. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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