Abstract
Background: Plaque composition may predict the evolution of carotid artery stenosis rather than its sole extent. The grey scale median (GSM) value is a reproducible and standardized value to report plaque echogenicity as an indirect measure of its composition. We monitored plaque composition in asymptomatic subcritical carotid stenosis and evaluated the effect of an oral modulating calcification factor (vitamin K2). Methods: Carotid plaque composition was assessed by GSM value. Monitoring the effects of standard therapy (acetylsalicylic acid and low–medium dosage statin) (acetylsalicylic acid (ASA) arm) or standard therapy plus vitamins K2 oral supplementation (ASA + K2 arm) over a 12 months period was conducted using an ultrasound scan in a prospective, open-label, randomized controlled trial (PLAK2). Results: Sixty patients on low–medium dosage statin therapy were enrolled and randomized (30 per arm) to either ASA + K2 or ASA alone. Thirty-seven patients (61.6%) showed at 12 months a stable plaque with a mean increase in the GSM value in respect to the baseline of 2.6% with no differences between the two study arms (p = 0.66). Fifteen patients (25%) showed an 8% GSM value reduction respect the baseline with no differences between the two study arms (p = 0.99). At multivariable analysis, the adjusted mean (95% confidence interval) GSM change per month from baseline was greater in the ASA + K2 arm (−0.55 points, p = 0.048) compared to ASA alone (−0.18 points, p = 0.529). Conclusions: Carotid plaque composition monitoring through GSM value represents a laborious procedure. Although its use may not be applied to everyday practice, a specific application consists in evaluating the effect of pharmacological therapy on plaque composition. This 12 months randomized trial showed that the majority of subcritical asymptomatic carotid plaque on treatment with low–medium dosage statin presented a stable or increased echogenicity. Although vitamin K2 beyond standard therapy did not determine a significant change in plaque composition, for those who presented with GSM reduction it did enhance a GSM monthly decline.
Highlights
Carotid artery stenosis is a major risk factor for stroke [1]
Statin therapy in carotid stenosis leads to an overall increase in plaque echogenicity, interpreted as a stability factor [8], recent studies have shown a correlation between carotid calcification and cerebral ischemic lesions contributing to cognitive impairment and mortality [9,10,11,12]
We considered current literature [8,20] describing the effect of statin therapy on plaque echogenicity assessed by a gray scale median (GSM) score that reported a plaque echogenicity increase from 16% to 29% at 12 months’ follow-up
Summary
Carotid artery stenosis is a major risk factor for stroke [1]. Current risk stratification to recommend surgical intervention beyond medical therapy is based on percent stenosis; this variable, does not completely reflect the real risk in many cases, as not all patients with significant stenosis will benefit from surgery, owing to stable plaques, whereas other patients without significant stenosis will experience neurological symptoms, owing to plaque vulnerability. Based on the plaque composition evaluation with doppler US and GSM application we monitored asymptomatic subcritical carotid artery stenosis on standard therapy and evaluated the effects of oral supplementation of vitamin K2 as a modulating factor in vascular calcification in 12 months trial [13,14,15,16,17,18,19]. We monitored plaque composition in asymptomatic subcritical carotid stenosis and evaluated the effect of an oral modulating calcification factor (vitamin K2). Its use may not be applied to everyday practice, a specific application consists in evaluating the effect of pharmacological therapy on plaque composition This 12 months randomized trial showed that the majority of subcritical asymptomatic carotid plaque on treatment with low–medium dosage statin presented a stable or increased echogenicity. Vitamin K2 beyond standard therapy did not determine a significant change in plaque composition, for those who presented with GSM reduction it did enhance a GSM monthly decline
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
