Incidence of bilateral intraplaque hemorrhage in carotid artery disease.

Stroke is an important source of morbidity and mortality in the USA. Carotid occlusive disease is associated with most cerebrovascular accidents, and carotid artery intraplaque hemorrhage is particularly important in the pathogenesis of cerebral ischemic symptoms. The authors' experience with intraplaque hemorrhage in patients undergoing bilateral carotid endarterectomy was reviewed to determine whether unilateral intraplaque hemorrhage is predictive of the condition occurring on the contralateral side. Forty-seven patients underwent staged bilateral carotid endarterectomy performed by one vascular surgeon. Each plaque was reviewed by a pathologist for the presence of intraplaque hemorrhage. Of these patients, 33 demonstrated intraplaque hemorrhage on the side of initial endarterectomy; 27 of these 33 (82%) had bilateral hemorrhage. It was concluded that intraplaque hemorrhage in the initially operated carotid atheroma is highly predictive of the condition occurring in the contralateral atheroma. Furthermore, aggressive follow-up in this patient population may be warranted.