Contrast-Enhanced Ultrasound Imaging of Carotid Plaque Neovascularization Is Useful for Identifying High-Risk Patients With Coronary Artery Disease

Deyama, Juntaro; Nakamura, Takamitsu; Takishima, Isao; Fujioka, Daisuke; Kawabata, Ken‐ichi; Obata, Jun–ei; Watanabe, Kazuhiro; Watanabe, Y.; Saitō, Yukio; Mishina, Hideto; Kugiyama, Kiyotaka

doi:10.1253/circj.cj-12-1529

Cited by 77 publications

(58 citation statements)

References 23 publications

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“…These findings highlight the role that detailed carotid ultrasonography can play in monitoring response to therapy. 23 Plaque imaging on ultrasonography has also been effectively used in selecting carotid revascularization candidates. Ballotta et al 6 used CEUS to select patients with symptomatic carotid plaques with < 50% stenosis.…”

Section: Ultrasound Plaque Imaging In Medical and Surgical Managementmentioning

confidence: 99%

Contemporary carotid imaging: from degree of stenosis to plaque vulnerability

Brinjikji¹,

Huston²,

Rabinstein

et al. 2016

JNS

279

172

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abbreviatioNs AHA = American Heart Association; CAS = carotid artery stenting; CEA = carotid endarterectomy; CEUS = contrast-enhanced ultrasonography; CTA = CT angiography; DCE = dynamic contrast-enhanced; DSCT = dual-source CT; FDG = fluorodeoxyglucose; FSE = fast spin echo; Gd = gadolinium; HU = Hounsfield units; IPH = intraplaque hemorrhage; LRNC = lipid-rich necrotic core; MDCT = multidetector-row CT; MDCTA = MDCT angiography; MES = microembolic signal; MMP-9 = matrix metalloproteinase-9; MRA = MR angiography; PDW = proton density-weighted; SUV = standardized uptake value; SUVmax = maximal SUV; TBR = target-to-background ratio; TCD = transcranial Doppler ultrasonography; TIA = transient ischemic attack; TOF = time of flight; USPIO = ultrasmall superparamagnetic iron oxide. Carotid artery stenosis is a well-established risk factor of ischemic stroke, contributing to up to 10%-20% of strokes or transient ischemic attacks. Many clinical trials over the last 20 years have used measurements of carotid artery stenosis as a means to risk stratify patients. However, with improvements in vascular imaging techniques such as CT angiography and MR angiography, ultrasonography, and PET/CT, it is now possible to risk stratify patients, not just on the degree of carotid artery stenosis but also on how vulnerable the plaque is to rupture, resulting in ischemic stroke. These imaging techniques are ushering in an emerging paradigm shift that allows for risk stratifications based on the presence of imaging features such as intraplaque hemorrhage (IPH), plaque ulceration, plaque neovascularity, fibrous cap thickness, and presence of a lipid-rich necrotic core (LRNC). It is important for the neurosurgeon to be aware of these new imaging techniques that allow for improved patient risk stratification and outcomes. For example, a patient with a low-grade stenosis but an ulcerated plaque may benefit more from a revascularization procedure than a patient with a stable 70% asymptomatic stenosis with a thick fibrous cap. This review summarizes the current state-of-the-art advances in carotid plaque imaging. Currently, MRI is the gold standard in carotid plaque imaging, with its high resolution and high sensitivity for identifying IPH, ulceration, LRNC, and inflammation. However, MRI is limited due to time constraints. CT also allows for high-resolution imaging and can accurately detect ulceration and calcification, but cannot reliably differentiate LRNC from IPH. PET/CT is an effective technique to identify active inflammation within the plaque, but it does not allow for assessment of anatomy, ulceration, IPH, or LRNC. Ultrasonography, with the aid of contrast enhancement, is a cost-effective technique to assess plaque morphology and characteristics, but it is limited in sensitivity and specificity for detecting LRNC, plaque hemorrhage, and ulceration compared with MRI. Also summarized is how these advanced imaging techniques are being used in clinical practice to risk stratify patients with low- and high-grade carotid artery stenosis....

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Section: Ultrasound Plaque Imaging In Medical and Surgical Managementmentioning

confidence: 99%

Contemporary carotid imaging: from degree of stenosis to plaque vulnerability

Brinjikji¹,

Huston²,

Rabinstein

et al. 2016

JNS

279

172

View full text Add to dashboard Cite

show abstract

“…It is therefore possible that instability of coronary plaque could be assessed by evaluating plaque instability in the carotid arteries. Our previous study also demonstrated that a higher grade of the carotid plaque neovascularization assessed using CEUS was associated with more severe and unstable coronary artery disease (CAD) that was characterized by more complex and extensive coronary lesions [20]. A recent report showed that contrast enhancement of the carotid artery, assessed using CEUS, had the potential to predict coronary events in patients with CAD [21].…”

Section: Introductionmentioning

confidence: 97%

Assessment of carotid plaque neovascularization using quantitative analysis of contrast-enhanced ultrasound imaging is useful for risk stratification in patients with coronary artery disease

Nakamura

Deyama

et al. 2015

International Journal of Cardiology

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“…CEUS has recently been used to visualize intraplaque neovascularization as an element of vulnerability. 4,[8][9][10][11][12] The source of neovascularization is direct branching from the vasa vasorum or the intimal surface. These areas are very fragile, and plaque hemorrhage can easily occur.…”

Section: Resultsmentioning

confidence: 99%

Use of Contrast-enhanced Carotid Ultrasonography in Preoperative Assessment for Carotid Artery Stenting

Hagiwara

Takada

Shimizu

et al. 2018

JNET

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Objective: Contrast-enhanced carotid ultrasonography (CEUS) is a new technique for assessing carotid artery plaques.The present study attempted to demonstrate the association between the findings of CEUS performed prior to carotid artery stenting (CAS) and plaque debris caught during CAS. Methods:This study was conducted with 16 patients (15 men, 1 woman; mean age: 74.8 years) who had undergone evaluation of carotid plaque vulnerability followed by CAS. The carotid plaque evaluation consisted of CEUS and MRI.The amount of debris retrieved during CAS was semi-quantitatively classified into three grades (large, moderate, and small) by three independent physicians based on inspection of photographs of retrieved debris. The existence of a correlation between CEUS findings and the amount of debris was examined.Results: Enhanced plaque on CEUS was observed in 7 of 16 patients. A large amount of debris was observed during CAS in four of the seven patients with CEUS-enhanced plaques that were also assessed as unstable on MRI, while two patients had a moderate amount and one patient had a small amount of debris. There were significant correlations between the amount of debris and plaque enhancement on CEUS, unstable plaque on MRI, and enhancement of plaque on CEUS with unstable plaque on MRI (p = 0.036, p = 0.029, p = 0.036, respectively). For the prediction of moderate to large amount of debris occurring in CAS, enhancement of plaque demonstrated by CEUS had a sensitivity of 66.7% and a specificity of 85.7%, unstable plaque determined by MRI had a sensitivity of 100% and a specificity of 42.9%, and enhancement of plaque by CEUS and unstable plaque determined by MRI had a sensitivity of 100% and a specificity of 75%. Conclusion:Plaque vulnerability assessment using the combination of CEUS and MRI can predict the amount of debris retrieved during CAS, while using CEUS alone proved to be insufficient.

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Contrast-Enhanced Ultrasound Imaging of Carotid Plaque Neovascularization Is Useful for Identifying High-Risk Patients With Coronary Artery Disease

Cited by 77 publications

References 23 publications

Contemporary carotid imaging: from degree of stenosis to plaque vulnerability

Contemporary carotid imaging: from degree of stenosis to plaque vulnerability

Assessment of carotid plaque neovascularization using quantitative analysis of contrast-enhanced ultrasound imaging is useful for risk stratification in patients with coronary artery disease

Use of Contrast-enhanced Carotid Ultrasonography in Preoperative Assessment for Carotid Artery Stenting

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