Abstract TP116: Prevalence, Risk Factors and Healing Rates of Duplex Detected Carotid Plaque Ulcers

Abstract

Introduction: Carotid plaque ulcers confer an increased risk for stroke and TIA in both symptomatic and asymptomatic carotid artery stenosis. In historical studies, smoking has been associated with carotid ulceration. Little is known about healing rates of ulcers or development of new ulcers. Carotid Duplex studies are easily obtained and repeated to non-invasively monitor progression of carotid stenosis. We aimed to determine prevalence, risk factors and healing rates of ultrasound detected carotid plaque ulcers in an outpatient neurosonology laboratory. Methods: We retrospectively reviewed our database of 5837 carotid Duplex studies performed in an outpatient ultrasound laboratory affiliated with the neurological department of an academic center. A carotid ulcer was defined as a deep indentation in a carotid plaque which had a minimum width of 2mm and a well-defined back wall, as determined by B-mode, color, and B-flow imaging. Results: A total of 3215 patients underwent a first Duplex study, and 2522 studies were obtained in follow-up. Of these 127(4%) patients had a carotid ulcer. Demographics were available on 111 patients. Ulceration was associated with increased age (69.1 ± 8.4 vs No 64.3 ± 13.5 years; p< 0.001), hypertension (90.1% vs 50.6%; p< 0.001), dyslipidemia (79.3% vs 64.7%; p< 0.001), coronary artery disease (CAD) (32.4% vs 16.3%; p< 0.001) and current smoking (19.8% vs 7.9%; p< 0.001). Ulcer was found on initial study in 82 (3%) patients. Ipsilateral degree of stenosis for patients with a carotid ulcer exceeded 50% in 36% (46/127). 65 ulcers were followed serially. Median number of scans was 6 over a mean follow-up of 42±30 months. 31/65 (48%) healed. No factors, including statin use, was associated with ulcer healing. Conclusions: We report a low prevalence of duplex detected carotid plaque ulcers. Ulceration was associated with traditional atherosclerotic risk factors including advanced age, hypertension, dyslipidemia, CAD and current smoking. Carotid ulcers healed in approximately 50% patients with follow-up, and, in a minority of patients, a new ulcer developed during serial studies. Factors associated with ulcer healing remain poorly understood.