Prospective Study About the Relationship Between CEUS of Carotid Intraplaque Neovascularization and Ischemic Stroke in TIA Patients

Li, Zhenzhou; Xu, Xianfeng; Ren, Lijie; Shao, Yingmei; Luo, Shuyu; Chen, Shenghua; Guan, Xiaoyun

doi:10.3389/fphar.2019.00672

Cited by 15 publications

(13 citation statements)

References 22 publications

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“…30,31 Furthermore, our findings suggested that carotid IPN identified in SMI is highly correlated to the evaluation of pathology. Previous studies have indicated IPN highly associated with ischemic stroke in TIA patients, 32 our findings also demonstrated patients with IPN detected by SMI more likely to be exposed to stroke or TIA. Our data supports the diagnostic efficacy of SMI in the detection of IPN.…”

Section: Discussionsupporting

confidence: 83%

Detection of Carotid Atherosclerotic Intraplaque Neovascularization Using Superb Microvascular Imaging: A Meta‐Analysis

Song

Xing

Zhang

et al. 2021

J of Ultrasound Medicine

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Objectives-Although superb microvascular imaging (SMI) (Toshiba/Canon, Tokyo, Japan) has enabled routine characterization of intraplaque neovascularization (IPN) features in patients with carotid stenosis, no reports have been published on the multicenter and large sample size research in this aspect. The efficacy of SMI in detecting carotid IPN has not been concluded. This study aimed to assess the efficacy of SMI comparing with contrastenhanced carotid ultrasonography (CEUS) in the detection of carotid IPN or pathologic evaluations of IPN correlated with a history of stroke or transient ischemic attack (TIA).Methods-Web of Science, Cochrane Library, PubMed, Embase, and Scopus were searched up to August 2020 to identify peer-reviewed human studies on the diagnostic accuracy of SMI in detecting IPN. For the selected study, the correlation coefficient R and Kappa index between SMI and CEUS in detecting IPN were calculated. The correlation coefficient R between SMI in identifying IPN and pathologic evaluations of IPN and the odds ratio of IPN detected by SMI and history of stroke or TIA were also extracted. The subgroup analysis was performed to indicate the source of heterogeneity.Results-Our search identified 11 reports enrolling a total of 605 carotid stenosis patients. Carotid IPN detected by SMI was significantly correlated with which detected by CEUS (R, 0.89; 95% CI, 0.80-0.94; P = .00, and Kappa index, 0.73; 95% CI, 0.67-0.80; P = .00). Notably, a significant correlation was observed in SMI in detecting IPN and pathologic evaluations of IPN (R, 0.52; 95% CI, 0.40-0.62; P = .00). The odds ratio of IPN detected by SMI and history of stroke or TIA was pooled summary with statistical significance (OR, 3.33; 95% CI, 1.78-6.23; P = .00). In subgroup analysis, lower heterogeneity was associated with the degree of carotid stenosis, patients from which country, and types of equipment.Conclusions-SMI and CEUS display an excellent agreement in detecting carotid IPN. IPN detected by SMI shows high consistency with pathologic evaluations of IPN. Individuals with carotid IPN are more likely to develop stroke or TIA than those without carotid IPN.

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Section: Discussionsupporting

confidence: 83%

Detection of Carotid Atherosclerotic Intraplaque Neovascularization Using Superb Microvascular Imaging: A Meta‐Analysis

Song

Xing

Zhang

et al. 2021

J of Ultrasound Medicine

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“…Previous studies reported that the echogenicity of the plaques was negatively correlated with the plaque neovascularization grades. Therefore, CEUS examination should be performed in patients with carotid plaques that are hypoechoic (types I and II) ( Staub et al, 2011 ; Li et al, 2019 ). Thus, assessing plaque vulnerability is a cost-effective risk stratification method in patients with asymptomatic carotid stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…Contrast-enhanced ultrasound (CEUS) is used to examine plaque vulnerability by visualizing intraplaque neovessels in real time. According to studies of symptomatic carotid stenosis patients, IPN assessment using CEUS is independently associated with an increased risk of ischemic stroke after adjusting for the degree of stenosis ( Li et al, 2019 ; Camps-Renom et al, 2020 ; Song et al, 2020 ). In addition, it may serve as a clinically useful tool for cardiovascular risk stratification in patients with coronary events ( Nakamura et al, 2015 ; Mantella et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Carotid Intraplaque Neovascularization and Future Vascular Events in Patients With Asymptomatic Carotid Stenosis

et al. 2022

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Objective: Intraplaque neovascularization is a marker of plaque vulnerability and is used to predict the risk of future vascular events in patients with symptomatic carotid stenosis; however, its association with asymptomatic carotid stenosis has not been prospectively evaluated. Therefore, this study aimed to explore the association between intraplaque neovascularization assessed using contrast-enhanced ultrasound and the occurrence of future ischemic events in asymptomatic patients diagnosed with carotid stenosis.Methods: We recruited patients with asymptomatic carotid stenosis from our center. Contrast-enhanced ultrasound was performed at baseline. The outcomes were ischemic stroke and cardiovascular events. We plotted Kaplan-Meier survival curves and performed a log-rank test to compare endpoint event probability in patients with and without grade 2 intraplaque neovascularization. Univariate and multivariate Cox proportional hazards models were used to assess predictors of future vascular events.Results: The data of 50 participants were included in the analysis (median follow-up, 43.7 months). Endpoint events occurred in 12 participants (24%). The Kaplan-Meier survival curves showed that patients with grade 2 intraplaque neovascularization had a higher probability of future vascular events than those with grades 0 and 1 (p < .05). Grade 2 intraplaque neovascularization (hazard ratio: 4.530, 95% confidence interval, 1.337–15.343, p < .05) was an independent predictor of future vascular events in patients with asymptomatic carotid stenosis.Conclusion: Grade 2 intraplaque neovascularization assessed using contrast-enhanced ultrasound independently predicted future ischemic events in patients with asymptomatic carotid stenosis, and contrast-enhanced ultrasound may be an effective screening method to identify high-risk subgroups of patients with asymptomatic carotid stenosis.

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“…8,9 The degree of enhancement of intraplaque neovascularisation is related to cardiovascular and cerebrovascular events. [10][11][12] Some studies reported that intraplaque neovascularisation assessed by CEUS correlates significantly with histopathological findings of the same lesions. Moreover, the enhancement of intraplaque neovascularisation, which was assessed using CEUS, was consistent with the density of plaque neovascularisation, which was detected by immunohistochemistry, in patients with severe carotid stenosis undergoing endarterectomy.…”

Section: Introductionmentioning

confidence: 99%

Carotid intraplaque neovascularisation as a predictive factor for future vascular events in patients with mild and moderate carotid stenosis: an observational prospective study

Cui

Xing

Zhou

et al. 2021

Ther Adv Neurol Disord

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Background: Intraplaque neovascularisation (IPN) increases the vulnerability of plaques, which makes them more likely to rupture and increases the risk of vascular events. However, it is unclear whether IPN can predict future vascular events (stroke recurrence and cardiovascular events). Previous studies on IPN have focused on patients with severe stenosis but overlooked patients with mild and moderate stenosis. This study aimed to investigate whether IPN assessed by contrast-enhanced ultrasonography (CEUS) in patients with mild and moderate degrees of stenosis is associated with future vascular events. Methods: One hundred and twenty-one patients participated in this study. 76 patients who met the inclusion and exclusion criteria were included in the final dataset of the study. IPN was graded from 0 to 2 according to the extent of the microbubbles assessed using CEUS. The degree of carotid stenosis was graded as mild, moderate, or severe. We recorded future vascular events during the follow-up. Univariate and multivariate logistic regression analyses were used to evaluate risk factors for future vascular events. Results: After a follow-up period of 30 ± 6 months, 30 patients (39.5%) experienced subsequent vascular events. Compared with the ‘non-recurrent’ group, the ‘recurrent’ group showed a higher proportion of grade 2 neovascularisation ( p < 0.05), and it was an independent predictor of subsequent vascular events (odds ratio 6.066, 95% confidence interval 1.565–23.512, p < 0.05). Furthermore, in patients with mild and moderate stenosis, future vascular events occurred in an unexpectedly high proportion (up to 42.9%). In the ‘recurrent’ group, 55% of patients with mild and moderate stenosis had grade 2 neovascularisation. Conclusion: IPN by CEUS was an independent predictor of future vascular events in patients with recent ischemic stroke, and the high proportion of neovascularisation in patients with mild and moderate stenosis requires more attention.

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Prospective Study About the Relationship Between CEUS of Carotid Intraplaque Neovascularization and Ischemic Stroke in TIA Patients

Cited by 15 publications

References 22 publications

Detection of Carotid Atherosclerotic Intraplaque Neovascularization Using Superb Microvascular Imaging: A Meta‐Analysis

Detection of Carotid Atherosclerotic Intraplaque Neovascularization Using Superb Microvascular Imaging: A Meta‐Analysis

Carotid Intraplaque Neovascularization and Future Vascular Events in Patients With Asymptomatic Carotid Stenosis

Carotid intraplaque neovascularisation as a predictive factor for future vascular events in patients with mild and moderate carotid stenosis: an observational prospective study

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