[Doppler ultrasonic evaluation of the embolism-causing potential of carotid artery plaques. Apropos of 113 macroscopic findings].

Comparison was made between precise descriptions of gross pathology of 113 carotid artery atheromatous plaques (69 symptomatic, 44 asymptomatic) operated upon by thromboendarterectomy and results of ultrasound-Doppler examinations, to determine possible specific ultrasound criteria for precise anatomical lesions. Echographic criteria studied were: ultrasonic structure of plaques; relation of plaque to wall; existence or absence of a solution of continuity; regular or irregular nature of endoluminal border of plaque; and finally the notion of discordance between degree of stenosis as shown by Doppler (D) and ultrasound (E) imaging (E much less than D). Principal results were as follows. Images of the regular, homogeneous highly echogenic plaques (36 cases) corresponded in 69.4% of cases to simple fibrous or calcified plaques with regular endoluminal borders. Irregular heterogeneous plaques (31 cases) were suggestive of irregular, friable and/or ulcerated material in 64.4% of cases. Weakly echogenic plaques (9 cases) suggested mainly thrombus (44.4%) or soft, friable plaques (33.3%). Plaques with solution of continuity do not correspond to a precise lesion but, in contrast, are specific (with weakly echogenic plaques) of the emboligenic character of the plaques (100%). The criterion ultrasound "Doppler was specific for thrombus in 75% of cases. In contrast, the thrombus can also demonstrate very different ultrasound images. Finally, in this study ultrasound-Doppler findings produced 3 false negatives (2.6%). Combined ultrasound-Doppler imaging allows quantitative evaluation and particularly qualitative assessment of carotid artery atheromatous lesions, with sufficiently reliable criteria to detect lesions of high emboligenic potential.