To the Editor.
—In their review, Fisher and coworkers1 make it clear that intrinsic plaque characteristics are an important, and, until recently, neglected, area of research in carotid artery disease. We would like to add that it is now possible, using high-resolution ultrasonography, to characterize the intrinsic nature of a carotid artery plaque as either homogeneous (without hemorrhage) or heterogeneous (with intrinsic intraplaque hemorrhage) with a high degree of accuracy.2 In a recently published study, we were able to identify the presence or absence of intraplaque hemorrhage with an accuracy of 90%, sensitivity of 94%, and specificity of 88%. The benefit of using ultrasound is that carotid plaques can be accurately characterized noninvasively, and, therefore, studied serially. We are currently following up patients with both homogeneous and heterogeneous plaques to determine their natural history.
Bluth E, Hughes RL. Importance of Carotid Artery Plaque Distribution and Hemorrhage. Arch Neurol. 1988;45(6):602. doi:10.1001/archneur.1988.00520300016005