Ultrasound Methods in the Evaluation of Atherosclerosis: From Pathophysiology to Clinic

Abstract

Atherosclerosis is a key pathological process that causes a plethora of pathologies, including coronary artery disease, peripheral artery disease, and ischemic stroke. The silent progression of the atherosclerotic disease prompts for new surveillance tools that can visualize, characterize, and provide a risk evaluation of the atherosclerotic plaque. Conventional ultrasound methods—bright (B)-mode US plus Doppler mode—provide a rapid, cost-efficient way to visualize an established plaque and give a rapid risk stratification of the patient through the Gray–Weale standardization—echolucent plaques with ≥ 50% stenosis have a significantly greater risk of ipsilateral stroke. Although rather disputed, the measurement of carotid intima-media thickness (C-IMT) may prove useful in identifying subclinical atherosclerosis. In addition, contrast-enhanced ultrasonography (CEUS) allows for a better image resolution and the visualization and quantification of plaque neovascularization, which has been correlated with future cardiovascular events. Newly emerging elastography techniques such as strain elastography and shear-wave elastography add a new dimension to this evaluation—the biomechanics of the arterial wall, which is altered in atherosclerosis. The invasive counterpart, intravascular ultrasound (IVUS), enables an individualized assessment of the anti-atherosclerotic therapies, as well as a direct risk assessment of these lesions through virtual histology IVUS.

Apolipoprotein Signature of HDL and LDL from Atherosclerotic Patients in Relation with Carotid Plaque Typology: A Preliminary Report

“…We have performed a shotgun proteomic analysis on highly purified HDL and LDL fractions from pooled plasma samples obtained through two ultracentrifugation steps in high-salt media from patients who underwent carotid endarterectomy and healthy controls, which allowed for the comparison of levels of tens of proteins simultaneously. Plasma samples from patients were pooled according to carotid plaque echogenicity using ultrasonography, a well-established non-invasive method to assess plaque characteristics and the severity of carotid stenosis [ 39 , 40 , 41 , 42 , 43 ]. The use of pooled samples represents the major limitation of the present study since each piece of data reported represents an average value while a measurement of the level of variation or dispersion from the average is missing.…”

“…Plaques were classified according to Gray-Weale classification [ 38 ] into five types: uniformly echolucent plaque (type 1), predominantly echolucent plaque with <50% echogenic areas (type 2), predominantly echogenic plaque with <50% echolucent areas (type 3), uniformly echogenic plaque (type 4), and plaque with heavy calcification and acoustic shadows (type 5). This method represents an effective and non-invasive way to detect and characterize atherosclerotic plaque in peripheral arteries and provides a rapid risk stratification of the patient through the Gray-Weale standardization [ 39 , 40 , 41 , 42 ]. Patients were sorted, according to the plaque typology, into “soft” ( n = 44), having a carotid plaque with hypoechoic features (types 1 and 2), and “hard” ( n = 31), having a carotid plaque with hyperechoic features (types 3, 4, and 5).…”

The Value of Contrast-Enhanced Ultrasound in the Evaluation of Carotid Web

“…Conventional ultrasound is a non-invasive, rapid, and convenient method. It can be repeated many times and has a wide range of applicability ( 13 ). Contrast-enhanced ultrasound (CEUS) is a non-invasive method developed using conventional ultrasound technology as a foundation that provides more information, better image quality, and more quantitative data through intravenous injection of contrast agent as tracer ( 13 ).…”

“…It can be repeated many times and has a wide range of applicability ( 13 ). Contrast-enhanced ultrasound (CEUS) is a non-invasive method developed using conventional ultrasound technology as a foundation that provides more information, better image quality, and more quantitative data through intravenous injection of contrast agent as tracer ( 13 ). CEUS can clearly show conditions in the lumen, such as whether there is a contrast filling defect, and evaluate the degree of thrombus formation in the lumen.…”

Lipids and Lipoproteins in Health and Disease

“…The current ultrasound methods for visualization and risk evaluation of atherosclerotic plaques are reviewed in detail [ 23 ].…”