Carotid plaques - 3 years analysis
Indentify the factoprs influencing the carotid plaque progresssion. All consecutive patients from the ANTIQUE study (Atherosclerotic Plaque Characteristics Associated with a Progression Rate of the Plaque and a Risk of Stroke in Patients with the Carotid Bifurcation Plaque Study – ClinicalTrials.gov Identifier: NCT02360137) who underwent all clinical and ultrasound examinations over a 36-month period were included in the analysis. The ANTIQUE study inclusion criteria were as follows: patient age 30–90 years; atherosclerotic plaque localized in the carotid bifurcation or proximal part of the internal carotid artery with a width of ≥2.0 mm in B-mode transverse plane; sufficient image quality of atherosclerotic plaque in the carotid bifurcation and internal carotid artery (ICA) using ultrasound; self-sufficiency defined as a modified Rankin Scale score of 0–2 points; and signed informed consent was provided. Exclusion criteria were serious disease with a low probability of survival for at least three years and other objective obstacles preventing regular six-month ultrasound scans. Clinical examination All patients underwent neurological and physical examinations at six-month intervals over the course of 36 months. The examinations included blood pressure (one measurement at rest after the sonographic examination), height, and weight measurements (including calculation of body mass index), collection of demographic and medical data (age, gender, and medical history), occurrence of diseases (arterial hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease, atrial fibrillation, myocardial infarction, or other cardiac diseases; stroke, including stroke type; and surgery or stenting of any vessels, including carotid arteries, coronary, or lower limb and other arteries), smoking, daily alcohol consumption dose, and medication use. Treatment All patients were treated using the “treating arteries instead of risk factors” strategy.
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Ultrasound examination Neurosonological examination was performed in all patients at standard conditions during the baseline visit, two weeks later, and then in six-month intervals within 36 months. Plaque width measurement was performed in the transverse section of carotid artery in the area of maximum plaque width. The measurement was performed five times using a wall perpendicular to the artery (Figure 1). The maximal measured plaque width was used for analysis. Plaque width measurement error (ME) was set as 99th percentile of the difference between the two measurements in two-week intervals. A stable plaque was defined as a plaque with the width difference between initial and final measurements of ˂1 ME. Total plaque area and plaque volume differences between the first and final examinations were subsequently measured in plaques evaluated as stable. All plaques with differences in total plaque area or plaque volume of ˃10% were excluded from the stable plaque group. A progressive plaque was defined as a plaque with a width difference between initial and final measurements of >2 ME.