Assessment of Carotid Intraplaque Neovascularization Using Superb Microvascular Imaging in High Risk of Stroke Individuals: Results From a Community-Based Study

Abstract

Background: Improved stroke risk stratification may improve stroke prevention. We aimed to study the value of a novel Doppler method, superb microvascular imaging (SMI), in correlating plaque thickness and evidence of intra-plaque neovascularization with a history stroke and TIA involving any cerebrovascular territory among community residents considered at high stroke risk.Methods: We selected residents aged at least 40 years from the Donghuashi community in China who had at least three stroke risk factors (including a history of stroke or TIA) and carotid plaque thickness of at least 1.5 mm (but without heavy calcification) and no history of carotid endarterectomy or stenting. In this cross-sectional study, each subject underwent carotid plaque examination with standard ultrasound and SMI. SMI evidence of plaque neovascularization was categorized as none or mild (Grade 1) or moderate or marked (Grade 2) and correlated with past history of stroke or TIA.Results: A total of 131 individuals (mean age 69 ± 8 years, 63% male) met the study inclusion criteria. SMI revealed no or mild neovascularization in 74 subjects (56.5%) and moderate or marked neovascularization in 57 subjects (43.5%). Subjects with moderate or marked neovascularization were more likely to have a history of any territory stroke or TIA, 43.9 vs. 17.6% (P = 0.001). Multivariate logistic regression analyses showed a thicker plaque (odds ratio: 2.272, 95% CI: 1.351–3.822, P = 0.002) and a history of stroke or TIA (odds ratio: 4.017, 95% CI: 1.719–9.387, P = 0.001) significantly correlated with evidence of moderate to marked intra-plaque neovascularization.Conclusions: Moderate to marked intraplaque neovascularization detected by SMI was more likely in subjects with a history of any territory stroke or TIA or thicker plaque. This indicates a potential new role of SMI in stratifying future risk of stroke or other arterial disease complications.

Vascular imaging of atherosclerosis: Strengths and weaknesses

“…Wang et al conducted a study in a population of 131 individuals at high stroke risk. Subjects with moderate or marked neovascularization as measured by SMI were more significantly more likely to have a history of stroke or transient ischemic attack [72]. SMI and CEUS have been shown to have good consistency in detecting neovascularization.…”

Detection of Carotid Atherosclerotic Intraplaque Neovascularization Using Superb Microvascular Imaging: A Meta‐Analysis

“…Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram shown in Figure 1, which demonstrates that a total of 95 reports were analyzed in the systematic search, 11 studies of which were met all inclusion criteria and included in our meta-analysis. 5,6,[8][9][10][12][13][14][15][16][17] The research population consisted of 605 patients (mean age, 66 years) and all patients had carotid stenosis >50% or carotid plaque thickness > 1.5 mm. We summarized the study characteristics in Table 1 and the methodological difference in Table 2.…”

“…While 4 studies reported the consistency of SMI in detecting IPN and pathologic evaluations of IPN. 5,9,14,17 The pooled summary correlation Canon Aplio500, L7.5 1.5 Canon Aplio500, L7.5 0.12 Sonovue 2.5 ml Wang et al 6 Canon Aplio500, L7.5 1.5 NA NA NA NA Zhu et al 12 Toshiba Aplio500, L7.5 NA Toshiba Aplio500, L7.5 NA SonoVue 4 ml Xie et al 13 Toshiba Aplio500, L7.5 NA Toshiba Aplio500, L7.5 NA Sonovue 1.2 ml Oura et al 10 Toshiba Aplio500, L7.5 1.5 Toshiba Aplio500, L7.5 0.19-0.26 Sonazoid 0.01 ml/kg Zhang et al 16 Toshiba Aplio500, L4-11 coefficient R was 0.52 (95% CI = 0.40-0.62, P = .00) and heterogeneity was I 2 = 20.0% (P = .28, Figure 3). The odds ratio of IPN detected by SMI and history of stroke or TIA was reported in 3 studies.…”

“…The odds ratio of IPN detected by SMI and history of stroke or TIA was reported in 3 studies. 6,8,13 For pooled summary, odds ratio was 3.33 (95% CI = 1.78-6.23, P = .00) and heterogeneity was I 2 = 0.0% (P = .37, Figure 4). Visual grading of blood flow signal in the plaque detected by SMI was reported in all included studies as follows: Oura et al used a two-grade scale 10 : grade 8,14,15 grade 0, no blood flow signal is found in the plaque; grade 1, one or several dot blood vessels were found in the plaque; grade 2, dot blood vessels and 1-2 linear blood vessels are found; grade 3, multiple linear blood vessels are visible (Reference [7]).…”

Vascular Imaging Techniques to Diagnose and Monitor Patients with Takayasu Arteritis: A Review of the Literature

“…The SMI technique for motion artifact-specific characteristic analysis enables filtering that eliminates only the motion artifact and facilitates visualization of low velocity blood flow [84]. One study showed that moderate to severe intraplaque neovascularization detected by SMI was more prevalent in subjects with a history of stroke or TIA or with thicker plaques [86]. SMI is a promising noninvasive alternative to CEUS for the assessment of carotid plaque stability [87] and may help prevent ischemic stroke (Figure 6a,b) [88].…”