Fissured fibrous cap of vulnerable carotid plaques and symptomaticity: are they correlated? Preliminary results by using multi-detector-row CT angiography

Cerebrovasc Dis. 2009;27(4):322-7. doi: 10.1159/000202008. Epub 2009 Feb 14.


Purpose: Carotid artery plaque with a disrupted fibrous cap is characterized by a higher tendency to rupture, resulting in a higher rate of transitory ischemic attack and stroke. The purpose of our study was to evaluate whether there is a statistically significant correlation between the presence of fissured fibrous cap (FFC) (assessed by using multi-detector-row CT angiography (MDCTA)) and ipsilateral symptomaticity.

Material and methods: 147 patients (105 males, 42 females; mean age 63 years, range 37-84) with a stenosis of at least 50% or a plaque alteration at sonography were retrospectively studied, yielding a total of 294 carotid arteries, by using a multi-detector-row CT (MDCT) scanner. A search for detection of FFC and a correlation with previously registered data about patients' symptomaticity by using statistical assessment were performed. Each examination was assessed independently by two readers and interobserver agreement was calculated.

Results: Among the 147 patients included in the study group, 15 were excluded because of inadequate quality images. In the 132 remaining patients, for a total of 264 carotids assessed, 30 FFCs were detected by using MDCTA and overall there were 36 symptomatic patients (12 ipsilateral symptomatic patients with FFC). A statistical correlation between the presence of FFC and symptomaticity (p = 0.0032) was found. The kappa value between readers was 0.781.

Conclusions: MDCT may depict FFC and the results of our study suggest that FFC may be used as an indicator for prediction of potential cerebrovascular pathology. The interobserver agreement obtained was good.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Angiography / methods
  • Carotid Arteries / diagnostic imaging*
  • Carotid Stenosis / complications*
  • Carotid Stenosis / diagnostic imaging*
  • Coronary Artery Disease / complications
  • Diabetes Complications / complications
  • Female
  • Humans
  • Hypertension / complications
  • Ischemic Attack, Transient / epidemiology*
  • Male
  • Middle Aged
  • Observer Variation
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Factors
  • Stroke / epidemiology*
  • Tomography, Spiral Computed / methods