The size of juxtaluminal hypoechoic area in ultrasound images of asymptomatic carotid plaques predicts the occurrence of stroke Stavros K. Kakkos, MD,

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Presentation transcript:

The size of juxtaluminal hypoechoic area in ultrasound images of asymptomatic carotid plaques predicts the occurrence of stroke Stavros K. Kakkos, MD, PhD, RVT, Maura B. Griffin, PhD, Andrew N. Nicolaides, FRCS, PhD, Efthyvoulos Kyriacou, PhD, Michael M. Sabetai, MD, PhD, Thomas Tegos, MD, PhD, Gregory C. Makris, MD, Dafydd J. Thomas, MD, FRCP, George Geroulakos, MD, PhD Journal of Vascular Surgery Volume 57, Issue 3, Pages 609-618.e1 (March 2013) DOI: 10.1016/j.jvs.2012.09.045 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 A, Normalized grayscale image of the origin of the internal carotid artery (ICA) showing an apparently hyperechoic plaque. B, Color flow image of the same plaque showing the jet of blood at the tightest part of the stenosis (90%-95% North American Symptomatic Carotid Endarterectomy Trial method) and a juxtaluminal black (hypoechoic) area (JBA) as a filling defect on the far wall component of the plaque. C, Segmented grayscale image of the same plaque before and after color contouring according to the gray level of pixels (grayscale: 0-25 = black; 26-50 = blue; 51-75 = green; 76-100 = yellow; 101-125 = orange; ≥125 = red). The larger JBA of the far wall component of the plaque measures 13.6 mm2. The larger JBA of the near wall component of the plaque measures 2.7 mm2. Journal of Vascular Surgery 2013 57, 609-618.e1DOI: (10.1016/j.jvs.2012.09.045) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 Kaplan-Meier plots showing ipsilateral cerebrovascular or retinal ischemic (CORI) event–free survival (A) and stroke-free survival (B), stratified by juxtaluminal black (hypoechoic) area (JBA). Standard error bars are shown for each curve; the number of patients at risk at each interval is shown at the bottom of each graph. Journal of Vascular Surgery 2013 57, 609-618.e1DOI: (10.1016/j.jvs.2012.09.045) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 Kaplan-Meier plots showing ipsilateral ischemic stroke-free survival (A) and fatal stroke–free survival (B), stratified by a juxtaluminal black (hypoechoic) area (JBA) size of 8 mm2. Standard error bars are shown for each curve; the number of patients at risk at each interval is shown at the bottom of each graph. Journal of Vascular Surgery 2013 57, 609-618.e1DOI: (10.1016/j.jvs.2012.09.045) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 4 A, Stenosis 90%-99% European Carotid Surgery Trial (83%-99% North American Symptomatic Carotid Endarterectomy Trial) (n = 325) and predicted annual stroke risk. B, Stenosis 70%-89% European Carotid Surgery Trial (50%-82% North American Symptomatic Carotid Endarterectomy Trial) (n = 598) and predicted annual stroke risk. C, Stenosis 50%-69% European Carotid Surgery Trial (<50% North American Symptomatic Carotid Endarterectomy Trial) (n = 198) and predicted annual stroke risk. DWA, Discrete white areas; JBA, juxtaluminal black (hypoechoic) area; TIA, transient ischemic attack. Journal of Vascular Surgery 2013 57, 609-618.e1DOI: (10.1016/j.jvs.2012.09.045) Copyright © 2013 Society for Vascular Surgery Terms and Conditions