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The clinical significance of carotid plaque haemorrhage.

The clinical picture with the pathology findings of 89 atheromatic plaques which were removed following endarterectomy of the internal carotid artery, for the purpose of determining the clinical significance of the haemorrhagic atheromatic plaque were correlated. Intraplaque haemorrhage was determined in 44 of the 57 plaques (72.2%) of symptomatic patients while in the asymptomatic patients haemorrhage was noted in 12 of the 32 plaques (37.5%) p < 0.001. The extent of haemorrhage was > 25% of the plaque thickness in 21 of 44 symptomatic plaques (47.72%) and in the asymptomatic plaques in 3 out of 12 (25%) p > 0.05. The incidence of ulceration of the intima, with or without the presence of thrombus, was more frequent in the haemorrhagic plaques (68.42%) as compared with the non-haemorrhagic (31.57%), without any significant difference between the symptomatic and asymptomatic plaques. Communication of haemorrhage with the lumen was observed in 8 of 24 plaques (33.33%), 7 of which (29.16%) were symptomatic. The presence of haemorrhage in the atheromatic plaque of the internal carotid artery does not seem to play any direct role in the pathogenesis of the symptoms but, nevertheless, it constitutes a significant indication of instability of the atheromatic plaque.