Abstract

Purpose: In carotid artery disease, correlation of carotid plaque morphology with the patients presenting symptoms has drawn conflicting conclusions. 
Objective: to correlate plaque morphology in carotid arteries and correlation of symptoms in stroke patient study in SPRC and neurology hospital, Dhaka, Bangladesh. 
Methods: All carotid endarterectomy procedures performed by one group of vascular surgeons at SPRC and Neurology Hospital and BSMMU Hospital, Dhaka, Bangladesh Dhaka, Bangladesh from January 2020 to June 2021 were included in this study. There were 551 carotid endarterectomy procedures completed within the study period. All endarterectomy specimens were inspected during the surgical procedure, and plaque characteristics were recorded by the surgeon immediately after the operation. Information related to demographics, comorbidities, and operative indications were recorded prospectively at the time of operation. All endarterectomy specimens were inspected during the procedure, and plaque characteristics were recorded immediately after operation. 
Results: There was a higher incidence of plaque ulceration in the transiently symptomatic and prior stroke groups (260 of 335 [77.61%] and 22 of 31 [70.96%]) than in the asymptomatic cohort (110 of 185 [59.45%]; p < 0.0001, X2 test). There was no significant difference in the incidence of plaque hemorrhage between the transiently symptomatic and prior stroke patients compared with the asymptomatic patients. There was no statistical difference for ulcerated plaque or plaque hemorrhage between the transiently symptomatic and prior stroke groups. Intraplaque hemorrhage occurred more frequently in patients with high-grade stenosis (90% to 99%) than in those with less than 90% stenosis (123 of 185 [66.48%] versus 62 of 185 [33.51%]; p = 0.01, X2 test). 
Conclusions: On gross examination of the carotid specimen in the operating room, plaque ulceration correlates with an initial presentation of amaurosis fugax, TIA, or prior stroke compared with patients operated on for asymptomatic disease. The presence of intraplaque hemorrhage is associated with more advanced stenosis of the internal carotid artery. These findings suggest that plaque morphology does play an important role in the presentation of carotid artery disease.