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Absolutely agreed Jim. While we all are impressed by those “ugly” plaques and I too “feel this is bad” the only thing that has correlated with risk of symptoms is the severity of stenosis. There is an US technology that can measure very small movement and there was some preliminary work done looking at the paradoxical motion of plaque surface. ie: when the low pressure inside the artery caused by the high velocity through the stenosis actually falls below the pressure inside the plaque / vaso vasorum, it serves to stress or tear off the fibrous cap. In fact, I sometimes wonder if we would be better off throwing away % stenosis and look at frequency/velocity or some derived value for sheer stress. This makes much more intuitive sense to me.  Dr. Beach – can you help??   

 

Bill Schroedter

Venice, Fl

 


From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Jim Baun, RVT
Sent: Thursday, March 16, 2006 10:25 AM
To: [log in to unmask]
Subject: Re: Plaque characterization

 

Agreed.  But this isn't about common sense.  It's about peer-reviewed, statistically correlated clinical data obtained from controlled studies.  In the 1980s the vascular surg lit. strongly supported the correlation between plaque types and clincial outomes (cva).  In the 1990s, the radiology lit. demonstrated little if any correlation. The pendulum appears to be swinging again with recent studies showing ugly plaques = bad outcomes. 

 

This is a broad historical comment and I haven't had time to do a meta-analysis of all the data acquired over the past 20 years, but on balance, I believe the data would support the conclusion that heterogeneity, irregular plaque surface, and intraplaque hemorhage all have been  associated with higher morbidity and mortality over the years.

 

jim baun

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