Carotid plaque surface echogenicity predicts cerebrovascular events: An Echographic Multicentric Swiss Study

J Neuroimaging. 2022 Nov;32(6):1142-1152. doi: 10.1111/jon.13026. Epub 2022 Jul 18.


Background and purpose: To determine the prognostic value for ischemic stroke or transitory ischemic attack (TIA) of plaque surface echogenicity alone or combined to degree of stenosis in a Swiss multicenter cohort METHODS: Patients with ≥60% asymptomatic or ≥50% symptomatic carotid stenosis were included. Grey-scale based colour mapping was obtained of the whole plaque and of its surface defined as the regions between the lumen and respectively 0-0.5, 0-1, 0-1.5, and 0-2 mm of the outer border of the plaque. Red, yellow and green colour represented low, intermediate or high echogenicity. Proportion of red color on surface (PRCS) reflecting low echogenictiy was considered alone or combined to degree of stenosis (Risk index, RI).

Results: We included 205 asymptomatic and 54 symptomatic patients. During follow-up (median/mean 24/27.7 months) 27 patients experienced stroke or TIA. In the asymptomatic group, RI ≥0.25 and PRCS ≥79% predicted stroke or TIA with a hazard ratio (HR) of respectively 8.7 p = 0.0001 and 10.2 p < 0.0001. In the symptomatic group RI ≥0.25 and PRCS ≥81% predicted stroke or TIA occurrence with a HR of respectively 6.1 p = 0.006 and 8.9 p = 0.001. The best surface parameter was located at 0-0.5mm. Among variables including age, sex, degree of stenosis, stenosis progression, RI, PRCS, grey median scale values and clinical baseline status, only PRCS independently prognosticated stroke (p = 0.005).

Conclusion: In this pilot study including patients with at least moderate degree of carotid stenosis, PRCS (0-0.5mm) alone or combined to degree of stenosis strongly predicted occurrence of subsequent cerebrovascular events.

Keywords: carotid plaque echogenicity; carotid plaque surface; degree of stenosis; duplex ultrasound; stroke.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Carotid Stenosis* / diagnostic imaging
  • Constriction, Pathologic
  • Humans
  • Ischemic Attack, Transient* / diagnostic imaging
  • Pilot Projects
  • Plaque, Atherosclerotic* / diagnostic imaging
  • Risk Factors
  • Stroke* / diagnostic imaging
  • Switzerland / epidemiology
  • Ultrasonography