Identification of Carotid ‘Vulnerable Plaque’ by Contrast-enhanced Ultrasonography: Correlation with Plaque Histology, Symptoms and Cerebral Computed Tomography

Faggioli, Gianluca; Pini, Rodolfo; Mauro, Raffaella; Pasquinelli, Gianandrea; Fittipaldi, Silvia; Freyrie, Antonio; Serra, Carla; Stella, Andréa

doi:10.1016/j.ejvs.2010.11.002

Cited by 80 publications

(62 citation statements)

References 31 publications

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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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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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“…The relationship between atherosclerotic plaque morphology in the carotid artery and cerebrovascular events has been of interest for many years [16,20,33,55,57]. Compositional factors contribute to the vulnerability of an atherosclerotic plaque to rupture, as opposed to degree of stenosis or patient symptoms [12].…”

Section: Introductionmentioning

confidence: 99%

Characterizing Phantom Arteries with Multi-channel Laser Ultrasonics and Photo-acoustics

Johnson

Wijk

Sabick

2014

Ultrasound in Medicine & Biology

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Multi-channel photoacoustic and laser-ultrasonic waves are used to sense the characteristics of proxies for healthy and diseased vessels. The acquisition system is non-contacting and non-invasive with a pulsed laser source, and a laser vibrometer detector. As the wave signatures of our targets are typically low in amplitude, we exploit multi-channel acquisition and processing techniques. These are commonly used in seismology, to improve the signal-to-noise ratio of our data. We identify vessel proxies with a diameter on the order of 1 mm, at a depth of 18 mm. Variations in scattered and photoacoustic signatures are related to differences in vessel wall properties and content. The methods described have the potential to improve imaging and better inform interventions for atherosclerotic vessels, such as the carotid artery.

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“…Plaque cap thickness has been correlated with plaque vulnerability. In a study of 22 patients, who underwent CEA, a greater number of plaques with cap thickness defined as <200 μm was found to be associated with cerebrovascular events (p=0.01) 57 . In another study, the histological analysis of 105 plaques in asymptomatic and symptomatic patients demonstrated that the presence of an echogenic cap was four times more frequent in the symptomatic ones than in those with asymptomatic plaques (p<0.05) 58 .…”

Section: Surfacementioning

confidence: 99%

Stratifying risk: asymptomatic carotid disease

et al. 2012

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Stroke generates significant healthcare expenses and it is also a social and economic burden. The carotid artery atherosclerotic plaque instability is responsible for a third of all embolic strokes. The degree of stenosis has been deliberately used to justify carotid artery interventions in thousands of patients worldwide. However, the annual risk of stroke in asymptomatic carotid artery disease is low. Plaque morphology and its kinetics have gained ground to explain cerebrovascular and retinal embolic events. This review provides the readers with an insightful and critical analysis of the risk stratification of asymptomatic carotid artery disease in order to assist in selecting potential candidates for a carotid intervention.

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Identification of Carotid ‘Vulnerable Plaque’ by Contrast-enhanced Ultrasonography: Correlation with Plaque Histology, Symptoms and Cerebral Computed Tomography

Abstract: CEUS with dB-E is indicative of the extent of plaque neovascularisation. It can be used therefore as a marker for vulnerable plaque.

Cited by 80 publications

References 31 publications

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

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

Characterizing Phantom Arteries with Multi-channel Laser Ultrasonics and Photo-acoustics

Stratifying risk: asymptomatic carotid disease

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