From the Guidelines
The carotid ultrasound findings of intimal thickening and mixed calcified and soft plaque at the carotid bifurcations, without narrowing, indicate early atherosclerotic disease, and thus, I strongly recommend implementing lifestyle modifications and considering medical therapy to prevent disease progression, as supported by the European guidelines on cardiovascular disease prevention in clinical practice 1. The presence of intimal thickening and plaque buildup, more pronounced on the left side, suggests an increased risk of cardiovascular events, and the absence of narrowing at this time presents an opportunity for early intervention.
- Key lifestyle modifications include:
- Adopting a Mediterranean or DASH diet low in saturated fats
- Engaging in regular aerobic exercise (aiming for 150 minutes weekly)
- Smoking cessation if applicable
- Maintaining a healthy weight
- Medical management may include:
- Statin medication (such as atorvastatin 10-20mg daily or rosuvastatin 5-10mg daily) to prevent plaque progression
- Aspirin 81mg daily if recommended by your physician based on your overall cardiovascular risk
- Blood pressure control to less than 130/80 mmHg
- Tight glucose control if you have diabetes These recommendations are in line with the guidelines for the management of patients with extracranial carotid and vertebral artery disease, which emphasize the importance of lifestyle modifications and medical therapy in preventing disease progression and reducing the risk of cardiovascular events 1. It is essential to note that while the current findings do not indicate significant narrowing, regular follow-up and monitoring of the carotid arteries are crucial to assess the effectiveness of the implemented measures and to adjust the treatment plan as necessary, as suggested by the guidelines for cardiovascular disease prevention in clinical practice 1.
From the Research
Carotid Artery Ultrasound Findings
- Intimal thickening bilaterally
- Mixed calcified and soft plaque in the region of the carotid bifurcation, left greater than right
- No narrowing
Clinical Implications
- The presence of intimal thickening and plaque in the carotid arteries is associated with an increased risk of cardiovascular events, such as stroke and myocardial infarction 2, 3, 4
- The detection of plaque and intimal thickening by carotid ultrasound can provide valuable information for cardiovascular risk stratification 5, 2, 3
- The type and characteristics of plaque, such as calcification and softness, can also provide information on the vulnerability of the plaque and the risk of cardiovascular events 2, 6
Management and Treatment
- Statin treatment has been shown to improve the prognosis of patients with advanced carotid atherosclerosis 3
- High-dose atorvastatin combined with aspirin has been shown to reduce inflammatory cytokine levels and carotid plaque area, but may also increase the risk of blood glucose abnormalities 6
- Regular monitoring of blood sugar and other biochemical parameters is necessary during treatment with statins and aspirin 6