The aim of this study was to evaluate whether
TTFCA (total triterpenic fraction of Centella asiatica), was effective, by modulating
collagen production, in a period of 12 months, increasing the echogenicity of echolucent plaques at the femoral bifurcation. Hypoechoic
atherosclerotic plaques have been found to be associated with an increased evidence of cerebrovascular events. In this type of plaques stromal composition is limited as the
collagen component is generally very low; the plaque composition is mainly due to
lipid accumulation or
thrombosis. The aim of this study was the evaluation of echogenicity of hyperechoic plaques and how it could be modified by a drug acting on the modulation of
collagen synthesis.
Antiplatelet agents were used in all patients;
cholesterol-lowering agents were used in 34% of patients in the treatment group and in 36% in the placebo group.
TTFCA was used at the dose of 60 mg thrice daily (oral
tablets). Of the 60 included subjects 26 completed the study in the treatment group and 24 in the placebo group. At inclusion the average GSM in the treatment group was 14 (SD 3) and 14.3 (SD 3) in controls. At 12 months GSM was increased up to 22.8 (SD 4) in the treatment group and it was 15 (SD 3) in controls. Considering texture no significant changes were observed in controls while a qualitative increase in homogenicity was observed in the
TTFCA group. Plaque size measured at the beginning and at the end of the study showed a median increase in size, in controls (23%; range 0%-44%); it was unchanged in the
TTFCA group (variation 7%; 4%-26%). In conclusion in the treatment group plaques increased in echogenicity and in homogenicity; size and
stenosis remained unchanged. Modulating the
scarring process within echolucent plaques (low echogenicity, high echolucency, with a very low
collagen/stromal component), possibly by
collagen modulation, makes plaques more stable. This has been achieved and documented in the present study by an increase in the gray-scale median (plaques become more echogenic, more 'white'). The variation in GSM is generally associated with a lower risk of wall
thrombosis,
rupture and embolization. These observations indicate a positive action of
TTFCA on the stabilization of hypoechoic, low-density femoral plaques.