Association between Carotid Plaque Features on CTA and Cerebrovascular Ischemia: A Systematic Review and Meta-Analysis

Baradaran, Hediyeh; Al‐Dasuqi, Khalid; Knight‐Greenfield, Ashley; Giambrone, Ashley E.; Delgado, Diana; Ebani, E.J.; Kamel, Hooman; Gupta, Ajay

doi:10.3174/ajnr.a5436

Cited by 73 publications

(50 citation statements)

References 36 publications

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“…Our results agree with previous findings (in carotid arteries), which suggested that larger plaques (defined by their width or height), were not associated with any particular composition or vulnerability characteristics [12,41]. Studies in coronary arteries showed no association between the lipid core size and plaque surface area [42].…”

supporting

confidence: 91%

“…Then, plaques with high lipid content were associated with a predominant lipid content in the 1st mm. Related with this, plaques would be vulnerable because of the overall lipid content and also due to the absence of a fibrous cap, associated with the lipid content prevailing in the 1st mm, characteristics that increase risk of erosions and ruptures that favor plaque accident [12,28,41]. Taking into account the above, assessing the composition of the 1st mm may be sufficient in case of limitations to determine the composition of the whole plaque.…”

mentioning

confidence: 99%

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Carotid and Femoral Atherosclerotic Plaques in Asymptomatic and Non-Treated Subjects: Cardiovascular Risk Factors, 10-Years Risk Scores, and Lipid Ratios’ Capability to Detect Plaque Presence, Burden, Fibro-Lipid Composition and Geometry

Marin

Bia

Zócalo

2020

JCDD

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Carotid and/or femoral atherosclerotic plaques (AP) assessment through imaging studies is an interesting strategy for improving individual cardiovascular risk (CVR) stratification and cardiovascular disease (CVD) and/or events prediction. There is no consensus on who would benefit from image screening aimed at determining AP presence, burden, and characteristics. Aims: (1) to identify, in asymptomatic and non-treated subjects, demographic factors, anthropometric characteristics and cardiovascular risk factors (CRFs), individually or grouped (e.g., CVR equations, pro-atherogenic lipid ratios) associated with carotid and femoral AP presence, burden, geometry, and fibro-lipid content; (2) to identify cut-off values to be used when considering the variables as indicators of increased probability of AP presence, elevated atherosclerotic burden, and/or lipid content, in a selection scheme for subsequent image screening. Methods: CRFs exposure and clinical data were obtained (n = 581; n = 144 with AP; 47% females). Arterial (e.g., ultrasonography) and hemodynamic (central [cBP] and peripheral blood pressure; oscillometry/applanation tonometry) data were obtained. Carotid and femoral AP presence, burden (e.g., AP number, involved territories), geometric (area, width, height) and fibro-lipid content (semi-automatic, virtual histology analysis, grayscale analysis and color mapping) were assessed. Lipid profile was obtained. Lipid ratios (Total cholesterol/HDL-cholesterol, LDL-cholesterol/HDL-cholesterol, LogTryglicerides(TG)/HDL-cholesterol) and eight 10-years [y.]/CVR scores were quantified (e.g., Framingham Risk Scores [FRS] for CVD). Results: Age, 10-y./CVR and cBP showed the highest levels of association with AP presence and burden. Individually, classical CRFs and lipid ratios showed almost no association with AP presence. 10-y./CVR levels, age and cBP enabled detecting AP with large surfaces (˃p75th). Lipid ratios showed the largest association with AP fibro-lipid content. Ultrasound evaluation could be considered in asymptomatic and non-treated subjects aiming at population screening of AP (e.g., ˃ 45 y.; 10-y./FRS-CVD ˃ 5–8%); identifying subjects with high atherosclerotic burden (e.g., ˃50 y., 10-y./FRS-CVD ˃ 13–15%) and/or with plaques with high lipid content (e.g., LogTG/HDL ˃ 0.135).

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supporting

confidence: 91%

mentioning

confidence: 99%

Carotid and Femoral Atherosclerotic Plaques in Asymptomatic and Non-Treated Subjects: Cardiovascular Risk Factors, 10-Years Risk Scores, and Lipid Ratios’ Capability to Detect Plaque Presence, Burden, Fibro-Lipid Composition and Geometry

Marin

Bia

Zócalo

2020

JCDD

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“…Also, differences in window width and level and in administered contrast amount and density can produce interoperator variability about the reported lumen size. In the evaluation of significant carotid stenosis, CTA yields an overall sensitivity of 97 % and specificity of 99 % [25].…”

Section: Karotis-erkrankungmentioning

confidence: 99%

Role of CEUS in Vascular Pathology

et al. 2021

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In recent years, the implementation of contrast-enhanced ultrasound (CEUS) in clinical practice has opened new horizons in the arterial pathologies research field, since this technique is able to supply new sets of data that can be crucial in patient management. The main applications of CEUS in the arterial system are the detection, characterization, and follow-up of carotid plaques and endoleaks after EVAR. Other situations in which CEUS was demonstrated to be a useful tool are large vessel vasculitis, dissections, and untreated aneurysms. In carotid atherosclerosis CEUS is not only able to acquire quantitative data about stenosis but also to perform a qualitative assessment of the plaque. The most important plaque features that CEUS is able to depict are ulceration, neovascularization, and the presence of inflammatory infiltrates. All of these factors contribute to plaque vulnerability. Thus, CEUS is crucial in order to allow better risk stratification and management of patients. In follow-up after EVAR, CEUS shows sensitivity and specificity values similar to CTA while ensuring several advantages, such as lower cost and the absence of ionizing radiation and nephrotoxic agents. Moreover, CEUS is able to offer real-time evaluation of endoleaks and thus is a useful tool in cases that are ambiguous on CTA. Most limitations are patient-related and are the same as in all other ultrasound techniques, such as high BMI and meteorism.

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“…Although mcMRI can detect large IPHs, it misses about half of small or heavily calcified IPHs . Of potentially greater concern, mcMRI cannot differentiate hemosiderin‐rich hemorrhage associated with rupture risk from calcification that indicates plaque stability and reduces the risk of arterial embolization by half …”

Section: Introductionmentioning

confidence: 99%

Quantitative susceptibility mapping of carotid plaques using nonlinear total field inversion: Initial experience in patients with significant carotid stenosis

Nguyen

Yan

et al. 2020

Magnetic Resonance in Med

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Purpose:To develop a nonlinear preconditioned total field-inversion algorithm using the MEDI toolbox (MEDInpt) for robust QSM of carotid plaques and evaluate its performance in comparison with a local field-inversion algorithm (STI Suite) previously applied to carotid QSM. Methods: Numerical simulation and in vivo carotid QSM were performed to compare the MEDInpt and STI Suite algorithms. Multicontrast MRI was used as the reference standard for detecting calcified plaque and intraplaque hemorrhage (IPH).A total of 5 healthy volunteers and 11 patients with at least one significant carotid artery stenosis were enrolled in this study. Results: In the numerical carotid phantom, the relative susceptibility errors for calcified plaque and IPH were reduced from −63.2% and −56.5% with STI Suite to −13.0% and −24.2% with MEDInpt, respectively. In humans, MEDInpt provided a higher QSM quality score and better detection of calcification and IPH than STI Suite. Although all calcifications and IPHs detected on multicontrast MRI could be seen on QSM obtained with MEDInpt, only 50% of calcified plaques and 83% of IPHs could be captured on QSM obtained with STI Suite. Conclusion: MEDInpt can resolve calcification and IPH in advanced atherosclerotic carotid plaques. Compared with STI Suite, MEDInpt provided better QSM quality and has the potential to improve the detection of these plaque components. K E Y W O R D S atherosclerosis, calcification, carotid plaques, intraplaque hemorrhage, quantitative susceptibility mapping (QSM) 1502 | NGUYEN Et al.

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Association between Carotid Plaque Features on CTA and Cerebrovascular Ischemia: A Systematic Review and Meta-Analysis

Abstract: BACKGROUND: CTA is a widely available imaging examination that may allow the evaluation of high-risk carotid plaque features.

Cited by 73 publications

References 36 publications

Carotid and Femoral Atherosclerotic Plaques in Asymptomatic and Non-Treated Subjects: Cardiovascular Risk Factors, 10-Years Risk Scores, and Lipid Ratios’ Capability to Detect Plaque Presence, Burden, Fibro-Lipid Composition and Geometry

Carotid and Femoral Atherosclerotic Plaques in Asymptomatic and Non-Treated Subjects: Cardiovascular Risk Factors, 10-Years Risk Scores, and Lipid Ratios’ Capability to Detect Plaque Presence, Burden, Fibro-Lipid Composition and Geometry

Role of CEUS in Vascular Pathology

Quantitative susceptibility mapping of carotid plaques using nonlinear total field inversion: Initial experience in patients with significant carotid stenosis

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