Significance of Plaque Ulceration in Symptomatic Patients With

Background and Purpose The importance of carotid plaque ulceration as a cause of cerebral ischemic symptoms remains uncertain. Moreover, its prominence in symptomatic patients with severe carotid stenosis is unknown. Methods The association between angiographically denned plaque ulceration and risk of subsequent stroke was assessed using Cox proportional hazards regression in 659 patients with severe (70 % to 99%) carotid stenosis from the North Ameri-can Symptomatic Carotid Endarterectomy Trial. Results Treatment assignment (medical versus surgical) and degree of ipsilateral stenosis were identified as having a significant influence on the results. The risk of ipsilateral stroke at 24 months for medically treated patients with ulcer-ated plaques increased incrementally from 26.3 % to 73.2 % as the degree of stenosis increased from 75 % to 95%. Fo