Koichi Nakaoka

Clinical implications of carotid artery remodeling in acute coronary syndrome: ultrasonographic assessment of positive remodeling.

OBJECTIVES We investigated the relationship between ultrasonographic features of the carotid artery and the angiographic features of coronary plaques in acute coronary syndrome (ACS). BACKGROUND The carotid intima-media thickness (IMT) may be a marker of advanced coronary artery disease. METHODS Consecutive ACS patients (N = 125) underwent B-mode ultrasonography within one week of the acute coronary event. Using a 7.5-MHz linear array transducer, the common carotid IMT, interadventitial diameter, and luminal diameter were examined. Carotid plaques were also assessed. Then patients were divided into two groups based on the number of complex plaques identified by coronary angiography. RESULTS The carotid IMT of 75 patients with multiple complex coronary plaques was significantly larger than that of 50 patients with solitary plaques (p < 0.0003). The prevalence of soft and hard carotid plaques was higher in the group with multiple coronary plaques than in those with single plaques (28% vs. 12%, p < 0.04 and 13% vs. 0%, p < 0.008, respectively). Additionally, the carotid interadventitial diameter was larger in the patients with multiple plaques than in those with single plaques (7.93 +/- 0.97 mm vs. 7.48 +/- 0.88 mm, p < 0.01), and a significant correlation was observed between the carotid IMT and interadventitial diameter (R = 0.54, p < 0.0001). CONCLUSIONS In ACS, multiple complex coronary plaques are associated with positive carotid remodeling, suggesting that plaque vulnerability may be a systemic phenomenon.