Obesity Phenotypes, Diabetes, and Cardiovascular Diseases
Age And Sex Differences In Carotid Plaque Progression Revealed By MRI
CAROTID plaque evolution is a critical factor in understanding stroke risk and vascular health. A recent study investigated the progression of subclinical carotid plaques by investigating how existing plaque compositions influence the development of new components within the same plaque. Notably, this study identified that plaques containing calcification are significantly more likely to develop intraplaque haemorrhage (IPH), a marker of plaque vulnerability, highlighting an important pathway in plaque progression that has not been widely explored.
The prospective study was conducted within the Rotterdam Study cohort, including 802 participants aged 45 and over with carotid intima-media thickness exceeding 2.5 mm. Each participant underwent two MRI scans of the carotid arteries, one at baseline and another after six years, using the same scanner to ensure consistency. Radiologists assessed plaque components such as calcification, IPH, and lipid-rich necrotic cores. Statistical analyses employed generalised estimating equations to model the relationship between baseline plaque compositions and the appearance of new components, adjusting for confounding variables. Age-specific probabilities of plaque evolution were calculated, and a 30-year simulation of plaque progression was performed using the Chapman–Kolmogorov equation.
Results demonstrated that plaques with existing calcification had twice the odds of developing IPH compared with those without calcification (adjusted odds ratio 2.00; 95% CI: 1.26–3.16; p=0.003). Over time, multicomponent plaques increased notably from 10% prevalence at age 55 to over 50% after age 70. Additionally, men were significantly more likely than women to progress from no or single-component plaques to multicomponent plaques containing IPH (21% versus 13%, p<0.001). Only a small fraction of plaques (2.9%) exhibited significant carotid stenosis, indicating that plaque composition changes precede severe narrowing.
In conclusion, the findings suggest that the presence of calcification in subclinical carotid plaques is a key predictor of IPH development and that plaque complexity increases substantially with age, particularly among men. These insights have clinical implications for identifying individuals at higher risk of plaque rupture and subsequent cerebrovascular events, potentially informing surveillance and management strategies. Limitations include the observational design, which cannot establish causality, and the use of MRI which may have detection thresholds. Further research is needed to explore interventions that might modify plaque progression and improve clinical outcomes.
Reference
Zuo L et al. Evolution of Subclinical Carotid Atherosclerotic Plaque Composition Using Serial MRI in the Rotterdam Study. Radiology. 2025;DOI: 10.1148/radiol.242248.
What To Know About Carotid Stent Surgery
Carotid stent surgery is one of two procedures that can be used to treat carotid artery stenosis. This procedure is considered a less invasive option with a faster recovery time. However, it does have risks.
Carotid stent surgery is a minimally invasive procedure used to treat carotid artery stenosis, a condition that's characterized by plaque buildup in the carotid arteries. The carotid arteries are major blood vessels located on either side of your neck that supply blood to your brain.
During carotid stent surgery, a stent (metal tube) is placed inside the carotid artery to keep it open so that blood can flow more easily without any obstruction.
Although carotid stenting is less commonly used to treat carotid artery stenosis than carotid endarterectomy, it's still considered an effective and relatively low risk procedure. Carotid endarterectomy is a procedure that involves the surgical removal of plaque that's built up inside the carotid artery.
Learn more about why this procedure may be recommended, who's a good candidate for it, and what the procedure involves.
Carotid stenting is used to treat a condition called carotid artery stenosis, which is when plaque builds up on the inside of your carotid arteries, which are located on either side of your neck.
Plaque is made up of cholesterol, fat, and calcium. When it builds up to unhealthy levels, a condition called atherosclerosis develops, which means the arteries have become a lot narrower. This makes it more difficult for blood to flow properly through these blood vessels to get to your brain. Carotid artery stenosis increases your risk of stroke.
Some factors that can raise your risk of developing carotid artery stenosis include:
According to a 2020 article, carotid stenting is usually recommended for people who have 50% stenosis along with symptoms, or people who have 70% stenosis but no symptoms.
Additionally, carotid stenting is usually recommended for people who need to avoid more invasive surgeries. This may include people who have:
Carotid stenting and carotid endarterectomy are the two main procedures used to treat carotid artery stenosis.
Most of the time, carotid endarterectomy is considered the preferred procedure to manage carotid artery stenosis. One of the reasons it's often favored over carotid stenting is because stenting carries a higher risk of stroke immediately after the procedure.
With carotid endarterectomy, a small incision is made in the neck, and the internal carotid artery is identified. A clamp is then placed on the artery to temporarily halt blood flow while the surgeon makes an incision to open up the artery.
Once the artery is open, the surgeon manually removes the plaque that has accumulated inside the blood vessel. The artery is then closed with sutures. The procedure is more invasive than carotid stenting and usually requires general anesthesia.
But there are times when carotid stenting may be preferable. This may be due to the following reasons:
Carotid stenting usually takes place in a hospital setting. Your healthcare professional will provide you with instructions about what you can and can't do prior to the procedure, including when you should stop eating and drinking.
Shortly before the procedure starts, you'll be given medication that will make you drowsy and relaxed.
Although there may be some variations, you can typically expect the following to happen during carotid stenting:
Carotid stent surgery typically involves an overnight stay in the hospital. You'll be carefully monitored to ensure you don't show any signs or symptoms of a stroke or bleeding.
Once you're cleared to go home, you'll be given instructions about the activities you can and can't do while you're recovering and what medications you need to take.
There isn't published research on how long it takes to recover from this procedure, but it usually involves a 24- to 48-hour stay in the hospital and about a week of rest at home.
Recovery time can vary from one person to another based on factors such as your age, overall health, and whether you have any other chronic health conditions.
The biggest risk associated with carotid stent surgery is that of a stroke immediately following the surgery. This can happen if a piece of plaque breaks away from the carotid artery wall during the procedure and travels to the brain.
According to a 2020 study, most strokes associated with carotid stenting are minor and not disabling. According to this study, the risk of stroke following the procedure is highest in people who are older than 70.
Other possible complications that may arise during carotid stent surgery include:
Carotid stent surgery is a procedure used to treat carotid artery stenosis, a condition that's caused by the buildup of plaque in the carotid arteries. This condition can greatly increase your risk of a stroke.
Carotid stent surgery has a high success rate of reducing your risk of stroke. However, the procedure does have risks. For some people, a more invasive procedure called carotid endarterectomy may be a better option.
If you have carotid artery stenosis, talk with your doctor about the risks and benefits of carotid stent surgery and carotid endarterectomy.
Carotid Stenosis
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The goal of treatment for carotid artery disease is to reduce the possibility of TIA or stroke, or to prevent the recurrence of a stroke.
Medical Therapy - Medications such as aspirin, other antiplatelets agents (like Plavix), diabetic medications, and medications that lower cholesterol and blood pressure are commonly prescribed when the degree of narrowing is less than 60 percent. Smoking cessation, exercise, and a healthy diet is also important for managing carotid artery disease and preventing further narrowing.
Carotid Endarterectomy - For patients with significant carotid artery narrowing with or without stroke-like symptoms, surgery may be recommended. Carotid Endarterectomy surgery involves exposing the carotid artery in the neck, clamping the artery above and below the plaque buildup, opening up the artery with a knife while it is clamped and directly removing the plaque (Figure 2).
Carotid Stenting - Alternatively, for select patients, carotid angioplasty and stenting, may be recommended. This procedure involves placing a self-expanding stent in the artery at the site of the narrowing and the stent expands holding the artery open (Figure 3), thereby, reducing the risk of future strokes.
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