Lumen Morphology in Mild-to-Moderate Internal Carotid Artery Stenosis Correlates with Neurological Symptoms

BACKGROUND: Several prospective studies have shown that carotid endarterectomy can reduce the risk for subsequent ischemic stroke in patients with 70-99% stenosis of the internal carotid artery (ICA). However, its benefits are still controversial in less than 70% stenosis of the ICA. There is increasing evidence that carotid lumen irregularities may correlate with neurological symptoms. Recent development of computed tomography angiography (CTA) can provide adequate information on the carotid plaque morphology. In this study, therefore, we aimed to clarify whether carotid lumen morphology estimated by CTA correlates with neurological symptoms in patients with 30-69% ICA stenosis. METHODS: This study included 67 carotid stenotic lesions with 30-69% ICA stenosis in 52 consecutive patients. These 67 lesions were examined by CTA from the viewpoints of the degree of stenosis, the prevalence of ulceration, and lumen morphology. Multivariate analysis was performed to detect significant predictors for the occurrence of ipsilateral ischemic events. RESULTS: Multivariate analysis showed that the irregular shape of the carotid lumen was the most powerful variable to predict symptomatic lesion in 30-69% ICA stenosis. CONCLUSIONS: These findings suggest that the morphology of carotid plaque may be associated with the occurrence of ipsilateral ischemic events in 30-69% ICA stenosis. J Neuroimaging 2011;21:348-354.