Recent Gross Intramural Plaque Hemorrhage in Asymptomatic High-Grade Carotid Stenosis

Abstract

The plaques of 124 consecutive primary carotid endarterectomies in 111 pa tients performed for asymptomatic 75% or greater diameter internal carotid stenosis were examined for gross intramural plaque hemorrhage. There were 74 endarterectomies in 61 asymptomatic patients (13 bilateral). Nineteen addi tional patients underwent unilateral carotid endarterectomy for asymptomatic stenosis prior to or concomitant with coronary artery bypass or abdominal aor tic operations, and another 31 patients had endarterectomy for asymptomatic stenosis after contralateral carotid endarterectomy for symptomatic carotid dis ease. Gross intramural plaque hemorrhage was present in 29 of the 124 plaques (23.4%). Of these, 15 were in the 31 (48.4%) patients who had a prior contralat eral carotid endarterectomy for symptomatic carotid disease (p < 0.001 by chi square), and 6 were in the 19 (31.6%) who had symptomatic aortic or coronary disease. Eight of the 74 (10.8%) plaques in 61 asymptomatic patients had hem orrhage. Patients taking aspirin, dipyridamole, or warfarin did not have an increased incidence of plaque hemorrhage. These findings indicate that patients with asymptomatic 75% or greater diameter carotid stenosis and either contra lateral symptomatic carotid disease or symptomatic coronary or abdominal aor tic disease may be at increased risk for neurologic events.