Journal of Vascular Surgery
Volume 46, Issue 6 , Pages 1147-1154 , December 2007

Intraobserver and interobserver variability and spatial differences in histologic examination of carotid endarterectomy specimens

  • Willem E. Hellings, MD

      Affiliations

    • Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
    • Corresponding Author InformationCorrespondence: W. E. Hellings, MD, Department of Vascular Surgery, Heidelberglaan 100, Room G04.130, 3584 CX Utrecht, The Netherlands.
  • ,
  • Gerard Pasterkamp, MD, PhD

      Affiliations

    • Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
  • ,
  • Anne Vollebregt

      Affiliations

    • Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
  • ,
  • Cees A. Seldenrijk, MD, PhD

      Affiliations

    • Department of Pathology, St. Antonius Hospital, Nieuwegein, The Netherlands
  • ,
  • Jean-Paul P.M. De Vries, MD, PhD

      Affiliations

    • Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, The Netherlands.
  • ,
  • Evelyn Velema, BSc

      Affiliations

    • Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
  • ,
  • Dominique P.V. De Kleijn, PhD

      Affiliations

    • Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
  • ,
  • Frans L. Moll, MD, PhD

      Affiliations

    • Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

Received 23 April 2007 ,Accepted 8 August 2007.

References 

  1. Verhoeven B, Hellings WE, Moll FL, de Vries JP, de Kleijn DP, de Bruin P, et al. Carotid atherosclerotic plaques in patients with transient ischemic attacks and stroke have unstable characteristics compared with plaques in asymptomatic and amaurosis fugax patients. J Vasc Surg. 2005;42:1075–1081
  2. Spagnoli LG, Mauriello A, Sangiorgi G, Fratoni S, Bonanno E, Schwartz RS, et al. Extracranial thrombotically active carotid plaque as a risk factor for ischemic stroke. JAMA. 2004;292:1845–1852
  3. Redgrave JN, Lovett JK, Gallagher PJ, Rothwell PM. Histological assessment of 526 symptomatic carotid plaques in relation to the nature and timing of ischemic symptoms: the Oxford plaque study. Circulation. 2006;113:2320–2328
  4. Davies MJ. The pathophysiology of acute coronary syndromes. Heart. 2000;83:361–366
  5. Falk E. Plaque rupture with severe pre-existing stenosis precipitating coronary thrombosis (Characteristics of coronary atherosclerotic plaques underlying fatal occlusive thrombi). Br Heart J. 1983;50:127–134
  6. Lee RT, Libby P. The unstable atheroma. Arterioscler Thromb Vasc Biol. 1997;17:1859–1867
  7. Ross R. Atherosclerosis–an inflammatory disease. N Engl J Med. 1999;340:115–126
  8. Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol. 2000;20:1262–1275
  9. Verhoeven BA, Velema E, Schoneveld AH, de Vries JP, de Bruin P, Seldenrijk CA, et al. Athero-express: differential atherosclerotic plaque expression of mRNA and protein in relation to cardiovascular events and patient characteristics (Rationale and design). Eur J Epidemiol. 2004;19:1127–1133
  10. Lovett JK, Gallagher PJ, Rothwell PM. Reproducibility of histological assessment of carotid plaque: implications for studies of carotid imaging. Cerebrovasc Dis. 2004;18:117–123
  11. Pasterkamp G, Schoneveld AH, van der Wal AC, Haudenschild CC, Clarijs RJ, Becker AE, et al. Relation of arterial geometry to luminal narrowing and histologic markers for plaque vulnerability: the remodeling paradox. J Am Coll Cardiol. 1998;32:655–662
  12. Fleiss JL, Cohen J. The equivalence of wieghted kapppa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Meas. 1973;33:613–619
  13. Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics. 1977;33:363–374
  14. Moll FL, Baker JD, Gomes AS. Observer variability with conventional and digital subtraction carotid angiograms. Eur J Vasc Surg. 1987;1:297–303
  15. Carr S, Farb A, Pearce WH, Virmani R, Yao JS. Atherosclerotic plaque rupture in symptomatic carotid stenosis. J Vasc Surg. 1996;23:755–765
  16. Puppini G, Furlan F, Cirota N, Veraldi G, Piubello Q, Montemezzi S, et al. Characterisation of carotid atherosclerotic plaque: comparison between magnetic resonance imaging and histology. Radiol Med (Torino). 2006;111:921–930
  17. Wasserman BA, Smith WI, Trout HH, Cannon RO, Balaban RS, Arai AE. Carotid artery atherosclerosis: in vivo morphologic characterization with gadolinium-enhanced double-oblique MR imaging initial results. Radiology. 2002;223:566–573
  18. Saam T, Ferguson MS, Yarnykh VL, Takaya N, Xu D, Polissar NL, et al. Quantitative evaluation of carotid plaque composition by in vivo MRI. Arterioscler Thromb Vasc Biol. 2005;25:234–239
  19. Hellings WE, Pasterkamp G, Verhoeven BA, De Kleijn DP, De Vries JP, Seldenrijk KA, et al. Gender-associated differences in plaque phenotype of patients undergoing carotid endarterectomy. J Vasc Surg. 2007;45:289–296
  20. Newby AC. Dual role of matrix metalloproteinases (matrixins) in intimal thickening and atherosclerotic plaque rupture. Physiol Rev. 2005;85:1–31
  21. Sluijter JP, Pulskens WP, Schoneveld AH, Velema E, Strijder CF, Moll F, et al. Matrix metalloproteinase 2 is associated with stable and matrix metalloproteinases 8 and 9 with vulnerable carotid atherosclerotic lesions: a study in human endarterectomy specimen pointing to a role for different extracellular matrix metalloproteinase inducer glycosylation forms. Stroke. 2006;37:235–239

 Competition of interest: none.

PII: S0741-5214(07)01346-8

doi: 10.1016/j.jvs.2007.08.018

Journal of Vascular Surgery
Volume 46, Issue 6 , Pages 1147-1154 , December 2007