Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Cerebrovasc Dis 2011;31:300–304 DOI: 10.1159/000320852 Carotid Plaque Morphology Improves Stroke Risk Prediction: Usefulness of a New Ultrasonographic Score P. Prati   a A. Tosetto   b M. Casaroli   a A. Bignamini   c L. Canciani   d N. Bornstein   e G. Prati   a P.J. Touboul   f a  Neurology Department, Gervasutta Hospital, Udine, b  Haematology Department, S. Bortolo Hospital, Vicenza, c  School of Specialization in Hospital Pharmacy, University of Milan, Milan, and d  GP, Udine, Italy; e  Neurology Department, Sourasky Medical Center, Tel Aviv, Israel; f  Neurology Department, Bichat University Hospital, Paris, France Introduction Noninvasive high-resolution B-mode imaging of the carotid arteries may improve the individual ischemic risk profile over and beyond the Framingham Stroke Risk Score in asymptomatic subjects [1–4]. Several studies have suggested that an increased intima media thickness of the common carotid artery is a good predictor of ath- erosclerotic plaques occurrence [5–7]. In turn, the pres- ence of carotid plaques is a powerful indicator of future ischemic events [8, 9]. The degree of stenosis is nowadays the most validated parameter for selecting symptomatic or asymptomatic patients for carotid surgery [10, 11]. However, other crite- ria may be crucial to characterize vascular risk and the consequently increased likelihood of occurrence of isch- emic events. The vulnerable plaque, underlying different molecu- lar changes and cellular mechanisms, is an attractive and speculative concept that has been assessed in a non con- clusive manner by different imaging markers [12, 13]. Few longitudinal population studies have, however, tried Key Words Prevention  Stroke  Ultrasound  Carotid  Plaque score Abstract Carotid thickening and plaque detected by B-mode imaging ultrasound are useful to improve the ischemic risk evaluation in asymptomatic subjects over and beyond the traditional cardiovascular risk factors. Some plaque’s echographic pa- rameters help describing the vascular risk. We hypothesized that the stenosis degree, plaque surface irregularity, echolu- cency and texture, compounded in a Total Plaque Risk Score (TPRS), are predictors of the ischemic events in the San Dan- iele study, a general population-based study of 1,348 sub- jects followed for 12 years in average. In the 171 subjects with at least one plaque at baseline, high TPRS was the most powerful independent predictor of cerebrovascular events, which occurred in 115 subjects. Addition of plaque charac- teristics significantly increased the area under the ROC curve (0.90 vs. 0.88, p = 0.04) versus the Framingham risk score alone. The TPRS is a potential new tool to improve the stroke risk prediction. Copyright © 2011 S. Karger AG, Basel Received: April 7, 2010 Accepted: August 27, 2010 Published online: January 4, 2011 Dr. Patrizio Prati Neurology Department, Gervasutta Hospital Via Gervasutta 48 ASS n° 4 ‘Medio Friuli’, IT–33100 Udine (Italy) Tel. +39 0432 553 360, Fax +39 0432 553 365, E-Mail patrizio.prati  @  tin.it © 2011 S. Karger AG, Basel 1015–9770/11/0313–0300$38.00/0 Accessible online at: www.karger.com/ced