The role of plaque morphology and diameter reduction in the development of new symptoms in asymptomatic carotid arteries

Abstract To determine the natural history of changes in plaque morphology and luminal diameter of atherosclerotic carotid arteries, we used duplex scanning to follow-up (1) the contralateral artery in 289 patients who had undergone carotid endarterectomy, with a mean follow-up 22 months and a range of 0 to 48 months and (2) the carotid arteries in 130 patients who had no surgical treatment and had been symptom free, with a mean follow-up period of 15 months and a range of 0 to 48 months. Plaques were graded as to the ratio of echolucency to echogenicity, with type 1 being most echolucent and type 4 being most echogenic. A normal-appearing artery was classified as type 5. Heterogeneous plaques (types 1 and 2) occurred significantly more ( p 75% stenoses fared worse than those with primary asymptomatic disease with >75% stenosis. Although the overall development of new symptoms is low in both populations, our data indicate that those patients with heterogeneous plaques or whose plaques have undergone change may be at risk for new symptoms. Longer follow-up studies are needed to define the role of plaque changes in the development of symptoms. For now we advocate a conservative "wait and see" approach to symptom-free patients with >75% stenoses and calcified plaques. We suggest a more aggressive approach, recommending early surgical intervention, to those few patients with heterogeneous plaques. (J Vasc Surg 1989;9:548–57.)