<sup>111</sup>
            In Platelet Scintigraphy for the Noninvasive Detection of Carotid Plaque Thrombosis

Manca, G; Parenti, G; Bellina, Riccardo; Boni, Giuseppe; Grosso, M; Bernini, W; Palombo, Carlo; Paterni, Marco; Pelosi, Gualtiero; Lanza, Maria; Mazzuca, N.; Bianchi, R.; Caterina, Raffaele De

doi:10.1161/01.str.32.3.719

Cited by 25 publications

(8 citation statements)

References 50 publications

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“…26 TCD studies of MES and surface thrombus are also conflicting. Sitzer et al 13 reported that MES were very common in plaques with ulceration and surface thrombus, whereas Manca and colleagues 29 detected MES in only 2 of 6 patients with histological evidence of surface thrombus. Although their sample was small, it is feasible that another mechanism may be responsible for MES independent of the presence of surface thrombus.…”

Section: Discussionmentioning

confidence: 99%

Source of Microembolic Signals in Patients With High-Grade Carotid Stenosis

Stork

Kimura

Levi

et al. 2002

Stroke

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Background and Purpose-In patients with both symptomatic and asymptomatic carotid artery stenoses, the relationship between carotid plaque characteristics and transcranial Doppler (TCD)-detected microembolic signals (MES) is unclear. The purpose of this study was to examine the relationship between macroscopically described plaque characteristics and MES in patients undergoing carotid endarterectomy. Methods-Sequential patients scheduled for carotid endarterectomy underwent preoperative 30-minute TCD monitoring of the ipsilateral middle cerebral artery to detect MES. TCD signal analysis, by researchers who were blinded to patient information, was performed offline. Clinical variables of patients and macroscopic carotid plaque features seen at surgery were documented prospectively. Results-Of the 109 patients (74 male, 35 female; mean age, 68.8Ϯ8.7 years) enrolled, 71 had ipsilateral carotid territory symptoms. MES were detected in 27 of all patients (25%). Twenty-two of 71 symptomatic patients (31%) compared with 5 of 38 asymptomatic patients (13%) had MES (Pϭ0.046). Also, symptomatic patients had more emboli (total MES counts) than asymptomatic patients (Pϭ0.010). The presence or absence of MES was not associated with plaque characteristics. Conclusions-Our data do not confirm previous reports of an association between MES and macroscopic plaque characteristics. We hypothesize that smaller platelet aggregates and fibrin clots, which are not detected macroscopically, are the most likely sources of TCD-detected MES. Key Words: carotid endarterectomy Ⅲ carotid stenosis Ⅲ middle cerebral artery Ⅲ ultrasonography, Doppler, transcranial C arotid stenosis is an important cause of ischemic stroke, with artery-to-artery embolism being the most common mechanism. In 1991, the European Carotid Surgery Trial (ECST) and North American Symptomatic Carotid Endarterectomy Trial (NASCET) investigators reported a beneficial effect in favor of carotid endarterectomy (CEA) in recently symptomatic patients with high-grade carotid artery stenosis. 1,2 The reduction in stroke risk is attributed to removal of the cerebral embolic source in most cases.Asymptomatic cerebral microembolic signals (MES) can be detected in patients with carotid stenosis through the use of transcranial Doppler (TCD). 3,4 Several observations suggest that MES detected distal to a high-grade carotid stenosis are due to unstable plaque. MES are more common among patients with recent carotid artery stroke and are more commonly detected among patients with more severe carotid artery narrowing. [5][6][7][8] Moreover, CEA tends to result in a rapid decline of MES, 9,10 suggesting that their temporal source has been removed.The frequency with which MES can be detected may depend on a number of factors such as duration of monitoring and the interval between symptom onset and TCD study. Reported incidence varies from Ϸ12% 11 to 100%. 9 MES may also be related to carotid plaque morphology. Valton et al 12 showed that MES were associated with carotid plaque ulceration on...

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Section: Discussionmentioning

confidence: 99%

Source of Microembolic Signals in Patients With High-Grade Carotid Stenosis

Stork

Kimura

Levi

et al. 2002

Stroke

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“…111 In-platelet scintigraphy was found to be an accurate non-invasive diagnostic tool to detect thrombotic complications in carotid plaques [149]. Despite these findings, prospective studies with this technique have not yet been performed.…”

Section: Nuclear Imaging Techniques For Detecting Atherosclerotic Plamentioning

confidence: 99%

Molecular imaging in atherosclerosis

Glaudemans

Slart

Bozzao

et al. 2010

Eur J Nucl Med Mol Imaging

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Atherosclerosis is the major cause of cardiovascular disease, which still has the leading position in morbidity and mortality in the Western world. Many risk factors and pathobiological processes are acting together in the development of atherosclerosis. This leads to different remodelling stages (positive and negative) which are both associated with plaque physiology and clinical presentation. The different remodelling stages of atherosclerosis are explained with their clinical relevance. Recent advances in basic science have established that atherosclerosis is not only a lipid storage disease, but that also inflammation has a fundamental role in all stages of the disease. The molecular events leading to atherosclerosis will be extensively reviewed and described. Further on in this review different modalities and their role in the different stages of atherosclerosis will be discussed. Non-nuclear invasive imaging techniques (intravascular ultrasound, intravascular MRI, intracoronary angioscopy and intravascular optical coherence tomography) and non-nuclear non-invasive imaging techniques (ultrasound with Doppler flow, electron-bean computed tomography, coronary computed tomography angiography, MRI and coronary artery MR angiography) will be reviewed. After that we focus on nuclear imaging techniques for detecting atherosclerotic plaques, divided into three groups: atherosclerotic lesion components, inflammation and thrombosis. This emerging area of nuclear imaging techniques can provide measures of biological activity of atherosclerotic plaques, thereby improving the prediction of clinical events. As we will see in the future perspectives, at present, there is no special tracer that can be called the diagnostic tool to diagnose prospective stroke or infarction in patients. Nevertheless, we expect such a tracer to be developed in the next few years and maybe, theoretically, it could even be used for targeted therapy (in the form of a beta-emitter) to combat cardiovascular disease.

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“…† Three studies used other forms of imaging 24,26,89 and some studied more than one imaging modality. Only 17 (23%) studies reported observer reproducibility of the imaging technique.…”

Section: Imagingmentioning

confidence: 99%

A Critical Appraisal of the Performance, Reporting, and Interpretation of Studies Comparing Carotid Plaque Imaging With Histology

Lovett¹,

Redgrave²,

Rothwell³

2005

Stroke

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Background and Purpose-Carotid plaque instability is an important determinant of stroke risk. There are now a number of different imaging techniques that provide information on carotid plaque morphology. However, it is unclear how they compare with one another or whether they can reliably assess plaque instability. Studies comparing imaging with pathology have shown highly variable results, even for similar imaging techniques. This may be because of variable pathology techniques rather than differences in imaging. Methods-We performed a systematic review of studies that compared carotid imaging with histology of the excised plaque published between January 1995 and September 2004. We assessed the quality and comparability of these studies. In particular, we determined which histology methods were used and whether observer reproducibility of the histology assessment was reported. Results-Among 73 eligible studies, histological methods were poorly reported and highly variable; 23% reported reproducibility data for imaging and only 12% reported reproducibility data for histology. Of 29 studies that reported quantitative results of blinded comparisons, there were methodological deficiencies and the results were highly variable.No study considered the extent to which the lack of reproducibility influenced the imaging-pathological correlations reported. Conclusions-Pathological correlation in studies of carotid plaque imaging cannot be reliably interpreted or compared because of incomparable and poorly reported histology methods. We make recommendations for the performance, reporting, and interpretation of imaging-pathological correlation studies and highlight the need for consensus guidelines.

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¹¹¹ In Platelet Scintigraphy for the Noninvasive Detection of Carotid Plaque Thrombosis

Cited by 25 publications

References 50 publications

Source of Microembolic Signals in Patients With High-Grade Carotid Stenosis

Source of Microembolic Signals in Patients With High-Grade Carotid Stenosis

Molecular imaging in atherosclerosis

A Critical Appraisal of the Performance, Reporting, and Interpretation of Studies Comparing Carotid Plaque Imaging With Histology

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111 In Platelet Scintigraphy for the Noninvasive Detection of Carotid Plaque Thrombosis

Cited by 25 publications

References 50 publications

Source of Microembolic Signals in Patients With High-Grade Carotid Stenosis

Source of Microembolic Signals in Patients With High-Grade Carotid Stenosis

Molecular imaging in atherosclerosis

A Critical Appraisal of the Performance, Reporting, and Interpretation of Studies Comparing Carotid Plaque Imaging With Histology

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Product

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¹¹¹ In Platelet Scintigraphy for the Noninvasive Detection of Carotid Plaque Thrombosis