Original title: Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS). Reference: Stavros K. Kakkos et al. J Vasc Surg 2013;57:609-18.

Despite multiple studies for a uniform approach to treat asymptomatic carotid lesions, it has not been achieved. Many factors have been proposed that contribute to the stratification including the severity of the stenosis, the plaque type, clinical, silent myocardial tomography, etc. A hypoechoic area close to the lumen of the artery corresponds with the histological finding of a vulnerable lipid core. 

The objective of this study was to test the hypothesis that the presence and size of hypoechoic areas close to the lumen could predict future ipsilateral ischemic events in asymptomatic patients. The study included 1,121 patients, followed by Doppler and clinically, every six months for a period of up to eight years, (mean 4 years). During follow-up there were 130 ipsilateral ischemic events in the population of which 59 were strokes, (12 of them fatal), 49 transient ischemic attacks and 22 amaurosis fugax. 

The average annual risk of events correlated linearly with the presence and size of hypoechoic areas near the vessel lumen diagnosed by ultrasound. Patients with hypoechoic areas

Conclusion: 

The size of the hypoechoic area near the lumen has a linear relationship with the risk of stroke and can be used to stratify asymptomatic patients. The results should be confirmed in future studies because they may change decisions for asymptomatic patients in which, historically, only the percentage of stenosis was used.

Commentary: 

The percentage of stenosis has a poor correlation with hypoechoic areas near the lumen vessel, (Pearson coefficient r = 0.083), which gives even more importance to this new setting. In fact, a hypoechoic area being used to discriminate asymptomatic patients is better for those with less severe injuries. 

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