Early identification of carotid vulnerable plaque in asymptomatic patients

Abstract

Background This study was to explore the influencing factors of atherosclerotic plaque formation and stability in patients with asymptomatic carotid atherosclerotic plaques, so as to identify the vulnerable plaques at early stage, and then find high-risk group of cardio-cerebrovascular events for early clinical intervention to reduce related mortality and disability. Methods A total of 302 enrolled patients with asymptomatic carotid atherosclerotic plaques were divided into 3 groups based on the results of carotid artery color Doppler ultrasound: atherosclerotic unstable plaque (UP) group, atherosclerotic stable plaque (SP) group, and control group without plaques. Serum markers were measured by ELISA. χ2 test, t test, Pearson correlation analysis, and Logistic multivariate regression analysis were used in the analysis, and P < 0.05 was considered statistically significant. Results It revealed that high MMP-9, LOX-1and YKL-40 were independent risk factors for unstable plaque formation. The area under the curve (AUC) of serum markers combined with MMP-9, LOX-1 and YKL-40 was 0.850, with sensitivity 87.67%, specificity 81.13%, and diagnostic accuracy 84.92%, which was significantly better than the individual diagnostic efficacy of other three factors. The accuracy rate of Crouse Plaque Score (CPS) in the diagnosis of vulnerable plaques was 61.90%, the 10-year ICVD diagnosis accuracy rate was 56.75%, and the diagnostic accuracy of serum markers was significantly better than CPS and 10-year ICVD. Conclusion Noninvasive cervical color Doppler ultrasound combined with serum markers MMP-9, LOX-1 and YKL-40 have significant early recognition effect on asymptomatic carotid vulnerable plaque patients.

Relationship between subclasses low-density lipoprotein and carotid plaque

“…Therefore, plaque stability can predict the occurrence of stroke, independent of the degree of stenosis [ 1 ]. The pathological characteristics affecting plaque stability include fibrous cap state, erosion and ulcer, core state, intraplate hemorrhage or neovascularization, intraplate hemorrhage, and the degree of plaque inflammation [ 8 , 17 ]. Similarly, exploring the effect of different LDL subclasses on plaque stability is more conducive for the prevention of stroke.…”

“…Measurement of carotid plaque thickness: Plaque thickness was expressed by intima-media thickness (IMT). When the measured IMT ≥ 1.2 mm, carotid atherosclerotic plaque formation was considered [ 8 ]. The presence of plaques in the common carotid artery, carotid bulb, and internal carotid artery was observed.…”

Implications of the heterogeneity between guideline recommendations for the use of low dose aspirin in primary prevention of cardiovascular disease

“…Ultrasound assessment of carotid plaque burden can also enhance ASCVD prediction using traditional risk factors in asymptomatic adults [ 42 , 43 ]. Carotid artery color Doppler ultrasound is a low-cost, non-invasive, simple procedure that is radiation-free and repeatable [44] . Globally, the burden of carotid atherosclerosis is substantial [45] , and systematic analysis of stroke rates reported in observational cohort studies shows that the risk of stroke is highly correlated with the degree of asymptomatic carotid stenosis [46] .…”

Identification Markers of Carotid Vulnerable Plaques: An Update

“…Worldwide, stroke contributes heavily to high mortality and disability rates [ 1 ]. The main pathological characteristic of stroke is atherosclerosis [ 2 ], which is a systemic, and inflammatory disease that is pathologically characterized by focal fibrosis, lipid accumulation and atherosclerotic plaques [ 2 ]. Commonly, based on stability, plaques can be classified into stable plaques and vulnerable plaques [ 2 ].…”

“…The main pathological characteristic of stroke is atherosclerosis [ 2 ], which is a systemic, and inflammatory disease that is pathologically characterized by focal fibrosis, lipid accumulation and atherosclerotic plaques [ 2 ]. Commonly, based on stability, plaques can be classified into stable plaques and vulnerable plaques [ 2 ]. Vulnerable plaques are referred to as those that easily rupture and subsequently cause thrombosis and severe clinical events, such as stroke [ 3 ].…”