Identifying vulnerable carotid plaques by noninvasive imaging

Abstract

Stroke results in considerable morbidity and mortality. Prevention is therefore of particular importance. On the basis of large clinical trials, carotid endarterectomy (CEA) is performed in selected patient groups to prevent stroke. Patient symptomatology and degree of carotid stenosis are the main clinical grounds to perform CEA. However, many individual patients undergo surgery with its attendant risks without taking advantage of it, whereas in others CEA is probably incorrectly withheld. There is therefore an urgent need for new adjuncts to identify high-risk subgroups of patients who particularly benefit from potentially hazardous interventions. Multiple noninvasive imaging modalities have shown their potential to differentiate high-risk, vulnerable carotid plaques from stable plaques. The ultimate goal is to implement one or a combination of these imaging modalities in daily clinical practice. This review gives an up-to-date overview of the clinical potential of these imaging modalities in identifying patients with carotid atherosclerosis who are at high risk for developing stroke. Advantages and limitations of each imaging technique are outlined. Additionally, recommendations for future research are presented.

Multimodality Imaging of Carotid Artery Plaques

“…Dynamic contrastenhanced MRI and ultra-small superparamagnetic particles of iron oxide-enhanced MRI are 2 other promising techniques to evaluate inflammation in carotid atherosclerotic plaques. 3 Future studies should investigate whether findings of these techniques correlate to 18 F-FDG PET. The accuracy of (other) promising CT and MRI techniques, such as dual-energy CT or a motion-sensitized driven-equilibrium MRI sequence (which can improve blood suppression), 25 should also be further explored.…”

“…2 Noninvasive imaging of carotid plaque characteristics may be used to improve patient selection for surgery. 3 However, it still remains to be investigated which modality is most effective. 18 F-fluoro-2-deoxyglucose positron emission tomography ( 18 F-FDG PET), 4,5 CT, 6,7 and MRI 8 -10 are widely available and are among the most promising tools.…”

Carotid Artery Duplex Scan in Diagnosing Coronary Atherosclerosis and Assessing Its Severity

“…Визуализация атеросклеротического поражения при помощи дуплексного сканирования СА позволяет достаточно точно оценить размер АСБ и выраженность стеноза артерии. Наиболее опасными представляются гетерогенные бляшки с тонкой покрышкой, с низкой эхогенностью и неровными кон-турами, что может указывать на изъязвление атеромы [5]. Примечательно, что количественное измерение АСБ не является стандартной практикой для большин-ства врачей; типичное описание АСБ включает оценку их количества, ТИМ, характеристику окружающих тка-достоверное увеличение доли мужчин (с 40% до 70,3%) и снижение доли женщин (с 60% до 30%) в группе с поражением обоих бассейнов.…”

Comparacoes preliminares entre a histologia virtual ultrassonografica in vivo e os achados histopatologicos da placa carotidea produto de endarterectomia

“…Extracranial carotid artery atherosclerosis is one of the major preventable causes of strokes, the second most common cause of death in developed countries, where they are responsible for 4.5 to 5 million deaths every year 1,2 . About 50% to 80% of all strokes are ischemic 1,3 , and of all ischemic strokes, 15% to 50% result from emboli and thrombi produced by the atherosclerotic plaque in the extracranial carotid artery bifurcation [1][2][3][4][5][6] .…”

“…About 50% to 80% of all strokes are ischemic 1,3 , and of all ischemic strokes, 15% to 50% result from emboli and thrombi produced by the atherosclerotic plaque in the extracranial carotid artery bifurcation [1][2][3][4][5][6] . However, not all plaque with marked stenosis becomes symptomatic and leads to a stroke or transient ischemic attack (TIA), which raises questions about whether surgery should be indicated for asymptomatic patients 7 .…”