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Measurement of Carotid Plaque Burden

J. David Spence, MD, FRCPC1
[+] Author Affiliations
1Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada
JAMA Neurol. 2015;72(4):383-384. doi:10.1001/jamaneurol.2014.3002.
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This viewpoint discusses the measurement of carotid plaque burden in determining cardiovascular risk factors.

In light of the 2 recent decisions from US authorities regarding the use of carotid ultrasonography, it is timely to highlight the measurement of carotid plaque burden, as being distinct from assessment of severity of carotid stenosis or measurement of carotid intima-media thickness (IMT). The US Preventive Services Task Force recommended against screening for asymptomatic carotid stenosis, and the American Medical Association approved a category 1 reimbursement code for carotid IMT and plaque scanning. These seemingly contradictory decisions call for an explanation.

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Figure.
Change in Plaque Burden in 3 Months

A, Soft plaque is shown at the origin of the left external carotid artery in a man in his 60s taking ezetimibe alone because of myalgias and cramps when taking statins. His plaque area had progressed from 20 mm2 six months earlier to 28 mm2 after stopping treatment with rosuvastatin. B, After restarting rosuvastatin therapy, 5 mg/d, with coenzyme Q10, 200 mg/d, to prevent myalgias, the plaque area regressed to 19 mm2 in just over 3 months. The plaque had also become denser, with regression of the soft plaque and more calcification. Reproduced with permission from Spence JD, Hackam DG. Treating arteries instead of risk factors: a paradigm change in management of atherosclerosis. Stroke. 2010;41(6):1193-1199.

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