Carotid intraplaque neovascularisation as a predictive factor for future vascular events in patients with mild and moderate carotid stenosis: an observational prospective study

Abstract

Background: Intraplaque neovascularisation (IPN) increases the vulnerability of plaques, which makes them more likely to rupture and increases the risk of vascular events. However, it is unclear whether IPN can predict future vascular events (stroke recurrence and cardiovascular events). Previous studies on IPN have focused on patients with severe stenosis but overlooked patients with mild and moderate stenosis. This study aimed to investigate whether IPN assessed by contrast-enhanced ultrasonography (CEUS) in patients with mild and moderate degrees of stenosis is associated with future vascular events. Methods: One hundred and twenty-one patients participated in this study. 76 patients who met the inclusion and exclusion criteria were included in the final dataset of the study. IPN was graded from 0 to 2 according to the extent of the microbubbles assessed using CEUS. The degree of carotid stenosis was graded as mild, moderate, or severe. We recorded future vascular events during the follow-up. Univariate and multivariate logistic regression analyses were used to evaluate risk factors for future vascular events. Results: After a follow-up period of 30 ± 6 months, 30 patients (39.5%) experienced subsequent vascular events. Compared with the ‘non-recurrent’ group, the ‘recurrent’ group showed a higher proportion of grade 2 neovascularisation ( p < 0.05), and it was an independent predictor of subsequent vascular events (odds ratio 6.066, 95% confidence interval 1.565–23.512, p < 0.05). Furthermore, in patients with mild and moderate stenosis, future vascular events occurred in an unexpectedly high proportion (up to 42.9%). In the ‘recurrent’ group, 55% of patients with mild and moderate stenosis had grade 2 neovascularisation. Conclusion: IPN by CEUS was an independent predictor of future vascular events in patients with recent ischemic stroke, and the high proportion of neovascularisation in patients with mild and moderate stenosis requires more attention.

The Value of Contrast-Enhanced Ultrasound in the Evaluation of Carotid Web

“…Furthermore, the median stenosis rate of CaW patients was 40% (IQR, 30–50%). Patients with mild to moderate stenosis were at an increased risk of future vascular events ( 32 ).…”

Carotid Intraplaque Neovascularization and Future Vascular Events in Patients With Asymptomatic Carotid Stenosis

“…Raw images were stored in the scanner’s hard drive for offline analysis. Routine carotid ultrasonography and CEUS examination were performed as previously described ( Cui et al, 2021 ).…”

International Union of Angiology (IUA) consensus paper on imaging strategies in atherosclerotic carotid artery imaging: From basic strategies to advanced approaches

“…Thus, it was shown in a meta-analysis that the prevalence of IPN was higher in SCS compared with ACS patients [15] and correlates with cardiovascular events [61]. Different prospective studies also demonstrated that in patients with a recent ischemic cerebrovascular event the risk of future ischemic stroke or TIA was significantly associated with IPN in carotid CEUS examination [62,63]. IPN on CEUS imaging was also found to be predictive of significant and complex coronary artery disease and future cardiovascular events [64].…”