Novel ultrasound techniques in the identification of vulnerable plaques—an updated review of the literature

Abstract

Atherosclerosis is an inflammatory disease partly mediated by lipoproteins. The rupture of vulnerable atherosclerotic plaques and thrombosis are major contributors to the development of acute cardiovascular events. Despite various advances in the treatment of atherosclerosis, there has been no satisfaction in the prevention and assessment of atherosclerotic vascular disease. The identification and classification of vulnerable plaques at an early stage as well as research of new treatments remain a challenge and the ultimate goal in the management of atherosclerosis and cardiovascular disease. The specific morphological features of vulnerable plaques, including intraplaque hemorrhage, large lipid necrotic cores, thin fibrous caps, inflammation, and neovascularisation, make it possible to identify and characterize plaques with a variety of invasive and non-invasive imaging techniques. Notably, the development of novel ultrasound techniques has introduced the traditional assessment of plaque echogenicity and luminal stenosis to a deeper assessment of plaque composition and the molecular field. This review will discuss the advantages and limitations of five currently available ultrasound imaging modalities for assessing plaque vulnerability, based on the biological characteristics of the vulnerable plaque, and their value in terms of clinical diagnosis, prognosis, and treatment efficacy assessment.

Mitochondrial Melatonin: Beneficial Effects in Protecting against Heart Failure

“…Lactate is then transported out of the cell via the monocarboxylate transporter (MCT), of which there are numerous subtypes [18]. Additionally, MCT transporters in endothelial cell membranes cause the uptake of lactate into these cells, which inactivates prolyl hydroxylase and stabilizes hypoxia-inducible factor-1α (HIF-1α); this promotes the ingrowth of blood vessels from the vasa vasorum in the adventitia and media of the artery into the plaque, making them more likely to rupture due to weakening of the cap [19,20]. Moreover, the additional blood vessels provide extra nutrients and oxygen, which support plaque progression and increase the likelihood of intraplaque hemorrhage [21].…”

Progress of Ultrasound Techniques in the Evaluation of Carotid Vulnerable Plaque Neovascularization

“…Ultrasound has gradually become one of the preferred methods for clinical screening and evaluation of IPN due to its advantages of fast, convenient, radiationfree, and low cost. It is difficult to detect the blood flow by conventional Doppler ultrasound due to the narrow inner diameter of IPN and its slow blood flow velocity [7,8]. CEUS and superb microvascular imaging (SMI) are the main non-invasive detection technologies for IPN due to their high sensitivity to fine and low-speed blood flow.…”