Computer analysis of ultrasonic plaque echolucency in identifying high risk carotid bifurcation lesions.

OBJECTIVES: to confirm that plaque echogenicity evaluated by computer analysis, as suggested by preliminary studies, can identify plaques associated with a high incidence of strokes. MATERIALS AND METHODS: a series of 96 patients with carotid stenosis in the range of 50-99% were studied retrospectively (41 with TIAs and 55 asymptomatic). Carotid plaque echogenicity was evaluated using a computerised measurement of the median grey scale value (GSM). All patients had a CT brain scan to determine the presence of infarction in the carotid territory. RESULTS: the incidence of ipsilateral brain CT infarctions was 16% in the asymptomatic and 32% in the symptomatic plaques (p =0.076). It was 20% for <70% stenosis and 25% for >70% stenosis (p =0.52). It was 9% for plaques which had a GSM >50 and 40% in those with GSM <50 (p <0.001) with a relative risk of 4.6 (95% CI 1.8 to 11.6). CONCLUSIONS: the results confirm that computer analysis of plaque echogenicity is better than the degree of stenosis in identifying plaques associated with an increased incidence of CT brain-scan infarction and consequently useful for identifying individuals at high risk of stroke. What is required is a form of image standardisation in order to apply this method to natural history studies with stroke as the endpoint.

[Supra-aortic vessels: anatomy and pathologic picture. Color-Doppler compared with clinico-surgical findings]. / Vasi sopra aortici: anatomia e quadri patologici. Confronto color-Doppler/reperti clinico-chirurgici.

Color-Doppler US is an extremely reliable technique in the study of atherosclerotic lesions of the supra-aortic trunks. It provides more complete and accurate information than angiography at the carotid bifurcation. A comparative study of US with arteriographic and surgical findings of carotid plaque specimens in 65 patients confirmed the reliability of color-Doppler US. A computerized graphic processing program of US images is here described, which was elaborated in order to evaluate and qualify the soft, the fibrotic and the calcific components of the plaque. The preliminary information yielded by the program was compared with histologic findings and the results appear to be extremely significant. Thus, the program could become a very useful tool for the follow-up of plaques over time.

[Current indications for lumbar ganglionectomy. Analysis of a series of cases]. / Indicazioni attuali alla gangliectomia lombare. Analisi di una casistica.

Data concerning a personal surgical series covering the last 10 years have been collected as far as cases regarded lumbar gangliectomy. The operative indication and incidence of this type of operation, performed for sclerotic obliterating arteriopathy of the lower extremities, out of total admissions and out of total direct reconstructive surgery operations, are analysed. Postoperative and long-term results of this type of surgery are then discussed. The data collected confirm the indication for lumbar gangliectomy alone or in association with other revascularization procedures in an albeit small number of patients, represented essentially by high risk cases or patients with extremely peripheral lesions.