Evaluation of carotid plaque vulnerability using shear-wave elastography: An observational comparative study

Sivasankar, Rajeev; Singh, Ramandeep; Hashim, PI; Soni, Brijesh Kumar; Patel, Rajneesh Kumar; Bajpai, Amit

doi:10.4103/jmms.jmms_31_19

Cited by 6 publications

(5 citation statements)

References 20 publications

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“…Further results, however, showed the percentage of plaques with a medium stiffness (range 3-5 m/s) to be higher in vulnerable than stable plaques (43 vs. 35%, p = 0:043) [24]. Five out of seven studies which compared plaques of symptomatic and asymptomatic patients reported YM of symptomatic plaques to be lower (27-52 kPa) compared to asymptomatic plaques (38-115 kPa) (p < 0:05) [9,[25][26][27][28]. In line with these findings, one study found mean shear wave velocity (SWV) to be negatively associated with symptomatic ischemic stroke (binary logistic regression coeffi-cient -0.624, constant -0.355, p = 0:004, odds ratio 0.54, 95% confidence interval 0.35-0.82) [29].…”

Section: Resultsmentioning

confidence: 93%

Shear Wave Elastography for the Assessment of Carotid Plaque Vulnerability: A Systematic Review

Mbroh,

Tünnerhoff,

Poli

et al. 2023

Acta Neurologica Scandinavica

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Evidence for the management of asymptomatic carotid stenosis and possibly symptomatic nonstenosing carotid artery disease is limited. In contrary to calcified plaques, soft plaques are considered vulnerable and prone to rupture. Shear wave elastography (SWE), a novel ultrasound technique which uses acoustic wave force to propagate shear wave in tissues, can quantify tissue stiffness through the estimation of Young’s modulus (YM) in kPa or shear wave velocity in meter/second. This systematic review is aimed at evaluating the feasibility of SWE in carotid plaque risk stratification in relation to ischemic stroke (PROSPERO registration: CRD42022309709). 18 studies, obtained via search on PubMed, Cochrane, and Embase from inception until November 1, 2022, assessed SWE’s feasibility in carotid plaque risk stratification in humans (13 studies) and phantom models (5 studies). Human studies showed heterogeneity with respect to SWE devices, acquisition settings, and methodology, which consequently reflected in the between-study variability of YM values used for distinguishing vulnerable/symptomatic (27–52 kPa) and stable/asymptomatic (28–115 kPa) carotid plaques. However, within-study assessment of all human studies indicated SWE’s feasibility in carotid plaque risk stratification. Furthermore, four out of five carotid plaque phantom studies showed the potential of SWE to discriminate tissues of different stiffness comparable to the carotid vessel wall, soft and hard plaques, and with good reproducibility. SWE may potentially offer a bedside risk stratification tool for identifying patients with vulnerable carotid plaques, who may benefit from carotid surgery, stenting, or prolonged dual antiplatelet therapy. Patients with stable carotid plaques could be spared the risks of potentially harmful treatments and complications. However, available data are not enough to facilitate the immediate clinical application of SWE, and therefore, larger prospective clinical are warranted.

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Section: Resultsmentioning

confidence: 93%

Shear Wave Elastography for the Assessment of Carotid Plaque Vulnerability: A Systematic Review

Mbroh,

Tünnerhoff,

Poli

et al. 2023

Acta Neurologica Scandinavica

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“…Sivasankar et al performed a prospective, observational, comparative study on 60 patients with atherosclerotic plaques, who were divided into two groups of 30 each, based on history of stroke [27]. They found significantly higher stiffness values in patients without history of stroke, concluding that SWE can be used as a tool for the early detection of vulnerable carotid artery plaques.…”

Section: Discussionmentioning

confidence: 99%

Role of Preoperative Ultrasound Shear-Wave Elastography and Radiofrequency-Based Arterial Wall Tracking in Assessing the Vulnerability of Carotid Plaques: Preliminary Results

et al. 2023

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We aimed at evaluating the ability of point shear-wave elastography (pSWE) and of a radiofrequency (RF) echo-tracking-based method in preoperatively assessing the vulnerability of the carotid plaque in patients undergoing carotid endarterectomy (CEA) for significant asymptomatic stenosis. All patients who underwent CEA from 03/2021 to 03/2022 performed a preoperative pSWE and an RF echo-based wall evaluation of arterial stiffness using an Esaote MyLab ultrasound system (EsaoteTM, Genova, Italy) with dedicated software. The data derived from these evaluations (Young’s modulus (YM), augmentation index (AIx), pulse-wave velocity (PWV)) were correlated with the outcome of the analysis of the plaque removed during the surgery. Data were analyzed on 63 patients (33 vulnerable and 30 stable plaques). In stable plaques, YM was significantly higher than in vulnerable plaques (49.6 + 8.1 kPa vs. 24.6 + 4.3 kPa, p = 0.009). AIx also tended to be slightly higher in stable plaques, even if it was not statistically significant (10.4 + 0.9% vs. 7.7 + 0.9%, p = 0.16). The PWV was similar (12.2 + 0.9 m/s for stable plaques vs. 10.6 + 0.5 m/s for vulnerable plaques, p = 0.16). For YM, values >34 kPa had a sensitivity of 50% and a specificity of 73.3% in predicting plaque nonvulnerability (area under the curve = 0.66). Preoperative measurement of YM by means of pSWE could be a noninvasive and easily applicable tool for assessing the preoperative risk of plaque vulnerability in asymptomatic patients who are candidates for CEA.

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“…Similar but heterogeneous angular velocities in the ex vivo vessel wall and plaque could be related to plaque composition and vesssel wall inhomogeneity but are difficult to correlate with histology. The stiffness of collagen-rich stable plaques is higher and more alike the surrounding wall stiffness compared to lipid-rich plaques that have rupture-prone features [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] . As the included plaque was stable, its stiffness could indeed be similar to the vessel wall.…”

Section: Discussionmentioning

confidence: 99%

“…The conversion from ARFI-induced wave velocities to tissue elasticity in carotid arteries is more complicated because not all assumptions for stiffness estimation are valid since arteries are thin, heterogeneous, and anisotropic [11] , [12] , influencing the wave propagation pattern. Nevertheless, multiple studies have shown the ability of arterial SWE to assess plaque vulnerability, as defined based on neurological symptoms [13] , [14] , [15] , [16] , [17] , [18] , histology [19] , [20] , [21] , [22] , American Heart Association classification of atherosclerotic plaques, plaque progression [18] , or echogenicity [13] , [15] , [20] , [23] .…”

Section: Introductionmentioning

confidence: 99%

“…Prior studies mainly performed ARFI-induced wave velocity measurements in the longitudinal vessel direction [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , whereas these measurements in the transverse plane could be complementary or beneficial. In the longitudinal view, stiffness can only be estimated and visualized in the anterior and posterior walls.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Extending arterial stiffness assessment along the circumference using beam-steered ARFI and wave-tracking: A proof-of-principle study in phantoms and ex vivo

Pruijssen,

Fekkes,

Menssen

et al. 2023

Computational and Structural Biotechnology Journal

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Evaluation of carotid plaque vulnerability using shear-wave elastography: An observational comparative study

Cited by 6 publications

References 20 publications

Shear Wave Elastography for the Assessment of Carotid Plaque Vulnerability: A Systematic Review

Shear Wave Elastography for the Assessment of Carotid Plaque Vulnerability: A Systematic Review

Role of Preoperative Ultrasound Shear-Wave Elastography and Radiofrequency-Based Arterial Wall Tracking in Assessing the Vulnerability of Carotid Plaques: Preliminary Results

Extending arterial stiffness assessment along the circumference using beam-steered ARFI and wave-tracking: A proof-of-principle study in phantoms and ex vivo

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