111In platelet scintigraphy for the noninvasive detection of carotid plaque thrombosis

Thrombosis on atherosclerotic lesions in the large extracranial arteries is the main cause of embolization in the distal cerebral circulation and thus is involved in the pathogenesis of ischemic stroke. The assessment of biological characteristics of lesions that are predictive of thrombotic complic...

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Bibliographic Details
Published in:Stroke (1970) 2001-03, Vol.32 (3), p.719-727
Main Authors: MANCA, Giampiero, PARENTI, Giuliano, MAZZUCA, Nicola, BIANCHI, Romano, DE CATERINA, Raffaele, BELLINA, Riccardo, BONI, Giuseppe, GROSSO, Mariano, BERNINI, Walter, PALOMBO, Carlo, PATERNI, Marco, PELOSI, Gualtiero, LANZA, Maria
Format: Article
Language:English
Subjects:
Aged
Angiography, Digital Subtraction
Biological and medical sciences
Blood Platelets - diagnostic imaging
Carotid Arteries - diagnostic imaging
Carotid Arteries - pathology
Carotid Artery Thrombosis - complications
Carotid Artery Thrombosis - diagnosis
Carotid Artery Thrombosis - surgery
Carotid Stenosis - complications
Carotid Stenosis - diagnosis
Carotid Stenosis - surgery
Endarterectomy, Carotid
Female
Gated Blood-Pool Imaging
Humans
Indium Radioisotopes
Lipids - analysis
Male
Medical sciences
Middle Aged
Neurology
Predictive Value of Tests
Reproducibility of Results
Sensitivity and Specificity
Stroke - etiology
Stroke - prevention & control
Technetium
Ultrasonography, Doppler, Duplex
Ultrasonography, Doppler, Transcranial
Vascular diseases and vascular malformations of the nervous system
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Summary:Thrombosis on atherosclerotic lesions in the large extracranial arteries is the main cause of embolization in the distal cerebral circulation and thus is involved in the pathogenesis of ischemic stroke. The assessment of biological characteristics of lesions that are predictive of thrombotic complications might help in stratification of the risk for stroke but is currently imperfect. We compared the performance of (111)In-platelet scintigraphy with blood pool subtraction, ultrasound-based tissue texture analyses, and transcranial Doppler techniques in their ability to predict the occurrence of superficial thrombosis or the presence of a lipid pool in carotid artery plaque specimens removed at the time of carotid endarterectomy in 22 patients with unilateral carotid artery stenosis of >70%. Positivity at (111)In-platelet scintigraphy was present in 8 patients and correctly identified the presence of thrombosis superimposed on a complicated plaque. Neither tissue texture analysis nor emboli detection by transcranial Doppler, performed in 12 patients, significantly identified plaque thrombosis. None of the techniques used were able to detect the presence of a significant lipid pool inside the plaque. Indium-platelet scintigraphy is an accurate noninvasive diagnostic tool to detect thrombotic complications in carotid plaques. Prospective studies should assess its ultimate value in risk stratification, possibly to guide the decision of whether to perform endarterectomy in selected patient categories.
ISSN:0039-2499
1524-4628