THE CLINICOMORPHOLOGICAL ASPECTS OF CAROTID PLAQUES AND DIAGNOSTIC ACCURACY OF COLOR DUPLEX SCANNING

P.O. Kazanchyan, I.A. Kazantseva, O.A. Alukhanyan, V.A. Popov, T.V. Rudakova, Yu.V. Debelyi
Department of Yascular Surgery, M.F. Vladimirsky Moscow Regional Research Clinical Institute,
Moscow, Russia

The present paper reports the morphological data on 125 atherosclerotic plaques of the carotid bifurcation. Of these plaques, 117 were processed histologically. As a result of the examination the atherosclerotic plaques were classified into two morphological types: uncomplicated and complicated plaques. The uncomplicated plaques were largely marked by severe fibrosis whereas the complicated plaques by intraplaque hemorrhage, rupture of the fibrous capsule of the plaque, ulceration and thrombus. It has been established that the complicated atherosclerotic plaques manifested clinically in 77(73%) cases. In 28 (27%) cases, they were asymptomatic (p<0.001). In the complicated plaques, the clinical picture of cerebrovascular insufficiency was most often (35%) associated with transient ischemic attacks (TIA). The clinical manifestations of cerebrovascular insufficiency were in a good agreement with the presented morphological substrates of the complicated plaques. The morphological data on 98 carotid plaques were compared to the color duplex scanning findings. Based on the combination of several ultrasound classifications and our own experienee we have proposed a simple classification suitable for clinical use. According to this classification, 22 plaques were assigned to type I, 29 to type II, 23 to type III, 13 to type IV, and 11 to type V, The surface of 57 plaques was smooth, that of 27 was irregular, and the surface of 14 plaques could not be classified. The presence of types I, II and III plaques was the cause of symptomatic impairment, of cerebral circulation in 25 (86%) cases, in 24 (83%) and in 14 (61%) cases (p^I<0.001, p^II<0.001, p^III>0.05 respectively); plaques with an irregular surface produced disorders in 23 (85%) cases. The diagnostic accuracy of duplex scanning in identification of the complicated plaques was 87% and that of the uncomplicated plagues 92%, with an overall accuracy of 87.5%. The errors of the technique were determined by the lack of experience and low quality scanograms obtained in the initial period of our investigation. The identification of the plaque structure was difficult in respect to calcified plaques. The settling of the problems of the treatment policy for the involved carotid artery and precautionary measures taken at operation, based on the data supplied by color duplex scanning enabled us to minimize the number of perioperative ischemic disorders of cerebral circulation and to improve the results of carotid artery reconstruction.

KEY WORDS: color duplex scanning, carotid plaque morphology.

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