Extracranial thrombotically active carotid plaque as a risk factor for ischemic stroke

被引:366
作者
Spagnoli, LG
Mauriello, A
Sangiorgi, G
Fratoni, S
Bonanno, E
Schwartz, RS
Piepgras, DG
Pistolese, R
Ippoliti, A
Holmes, DR
机构
[1] Univ Roma Tor Vergata, Dept Cardiovasc Dis, Div Vasc Surg, I-00133 Rome, Italy
[2] Minneapolis Cardiovasc Res Inst, Minneapolis, MN USA
[3] Mayo Clin & Mayo Fdn, Dept Neurol Surg, Rochester, MN 55905 USA
[4] Mayo Clin & Mayo Fdn, Dept Internal Med, Rochester, MN 55905 USA
[5] Mayo Clin & Mayo Fdn, Dept Cardiovasc Dis, Rochester, MN 55905 USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2004年 / 292卷 / 15期
关键词
D O I
10.1001/jama.292.15.1845
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context Recent studies suggest that factors other than the degree of carotid stenosis are involved in ischemic stroke pathogenesis, especially modifications of plaque composition and related complications. Objective To examine the role of carotid plaque rupture and thrombosis in ischemic stroke pathogenesis in patients undergoing carotid endarterectomy, excluding those with possible cardiac embolization or with severe stenosis of the circle of Willis. Design, Setting, and Patients A total of 269 carotid plaques selected from an interinstitutional Carotid Tissue Bank were studied by histology after surgical endarterectomy between January 1995 and December 2002. A total of 96 plaques were from patients with ipsilateral major stroke, 91 plaques from patients with transient ischemic attack (TIA), and 82 plaques from patients without symptoms. Main Outcome Measures Differences in the frequency of thrombosis, cap rupture, cap erosion, inflammatory infiltrate, and major cardiovascular risk factors between study groups. Results A thrombotically active carotid plaque associated with high inflammatory infiltrate was observed in 71 (74.0%) of 96 patients with ipsilateral major stroke (and in all 32 plaques from patients operated within 2 months of symptom onset) compared with 32 (35.2%) of 91 patients with TIA (P<.001) or 12 (14.6%) of 82 patients who were without symptoms (P<.001). In addition, a fresh thrombus was observed in 53.8% of patients with stroke operated 13 to 24 months after the cerebrovascular event, An acute thrombus was associated with cap rupture in 64 (90.1%) of 71 thrombosed plaques from patients with stroke and with cap erosion in the remaining 7 cases (9.9%). Ruptured plaques of patients affected by stroke were characterized by the presence of a more severe inflammatory infiltrate, constituted by monocytes, macrophages, and T lymphocyte cells compared with that observed in the TIA and asymptomatic groups (P=.001). There was no significant difference between groups in major cardiovascular risk factors. Conclusion These results demonstrate a major role of carotid thrombosis and inflammation in ischemic stroke in patients affected by carotid atherosclerotic disease.
引用
收藏
页码:1845 / 1852
页数:8
相关论文
共 38 条
[1]   Multiple levels of regulation of the interleukin-6 system in stroke [J].
Acalovschi, D ;
Wiest, T ;
Hartmann, M ;
Farahmi, M ;
Mansmann, U ;
Auffarth, GU ;
Grau, AJ ;
Green, FR ;
Grond-Ginsbach, C ;
Schwaninger, M .
STROKE, 2003, 34 (08) :1864-1869
[2]   Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis [J].
Barnett, HJM ;
Taylor, W ;
Eliasziw, M ;
Fox, AJ ;
Ferguson, GG ;
Haynes, RB ;
Rankin, RN ;
Clagett, GP ;
Hachinski, VC ;
Sackett, DL ;
Thorpe, KE ;
Meldrum, HE ;
Spence, JD .
NEW ENGLAND JOURNAL OF MEDICINE, 1998, 339 (20) :1415-1425
[3]  
BARNETT HJM, 1978, NEUROLOGY, V28, P769
[4]   Juxtalumenal location of plaque necrosis and neoformation in symptomatic carotid stenosis [J].
Bassiouny, HS ;
Sakaguchi, Y ;
Mikucki, SA ;
McKinsey, JF ;
Piano, G ;
Gewertz, BL ;
Glagov, S .
JOURNAL OF VASCULAR SURGERY, 1997, 26 (04) :585-594
[5]   Pregnancy-associated plasma protein a as a marker of acute coronary syndromes [J].
Bayes-Genis, A ;
Conover, CA ;
Overgaard, MT ;
Bailey, KR ;
Christiansen, M ;
Holmes, DR ;
Virmani, R ;
Oxvig, C ;
Schwartz, RS .
NEW ENGLAND JOURNAL OF MEDICINE, 2001, 345 (14) :1022-1029
[6]   Atherosclerotic plaque rupture in symptomatic carotid artery stenosis [J].
Carr, S ;
Farb, A ;
Pearce, WH ;
Virmani, R ;
Yao, JST .
JOURNAL OF VASCULAR SURGERY, 1996, 23 (05) :755-765
[7]   Role of inflammation in stroke and atherothrombosis [J].
Chamorro, A .
CEREBROVASCULAR DISEASES, 2004, 17 :1-5
[8]   Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) [J].
Cleeman, JI ;
Grundy, SM ;
Becker, D ;
Clark, LT ;
Cooper, RS ;
Denke, MA ;
Howard, WJ ;
Hunninghake, DB ;
Illingworth, DR ;
Luepker, RV ;
McBride, P ;
McKenney, JM ;
Pasternak, RC ;
Stone, NJ ;
Van Horn, L ;
Brewer, HB ;
Ernst, ND ;
Gordon, D ;
Levy, D ;
Rifkind, B ;
Rossouw, JE ;
Savage, P ;
Haffner, SM ;
Orloff, DG ;
Proschan, MA ;
Schwartz, JS ;
Sempos, CT ;
Shero, ST ;
Murray, EZ .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2001, 285 (19) :2486-2497
[9]   THROMBOSIS AND ACUTE CORONARY-ARTERY LESIONS IN SUDDEN CARDIAC ISCHEMIC DEATH [J].
DAVIES, MJ ;
THOMAS, A .
NEW ENGLAND JOURNAL OF MEDICINE, 1984, 310 (18) :1137-1140
[10]   Pathobiology of ischaemic stroke: an integrated view [J].
Dirnagl, U ;
Iadecola, C ;
Moskowitz, MA .
TRENDS IN NEUROSCIENCES, 1999, 22 (09) :391-397