Vasa Vasorum and Plaque Neovascularization on Contrast-Enhanced Carotid Ultrasound Imaging Correlates With Cardiovascular Disease and Past Cardiovascular Events

Abstract

Background and Purpose-Histological data associate proliferation of adventitial vasa vasorum and intraplaque neovascularization with vulnerable plaques represented by symptomatic vascular disease. In this observational study, the presence of carotid intraplaque neovascularization and adventitial vasa vasorum were correlated with the presence and occurrence of cardiovascular disease (CVD) and events (CVE). Methods-The contrast-enhanced carotid ultrasound examinations of 147 subjects (mean age 64Ϯ11 years, 61% male)were analyzed for the presence of intraluminal plaque, plaque neovascularization (Grade 1ϭabsent; Grade 2ϭpresent), and degree of adventitial vasa vasorum (Grade 1ϭabsent, Grade 2ϭpresent). These observations were correlated with preexisting cardiovascular risk factors, presence of CVD, and history of CVE (myocardial infarction and transient ischemic attack/stroke). Results-The presence of intraluminal carotid plaque was directly correlated to cardiovascular risk factors, CVD, and CVE (PϽ0.05). Adventitial vasa vasorum Grade 2 was associated with significant more subjects with CVD than vasa vasorum Grade 1 (73 versus 54%, Pϭ0.029). Subjects with intraplaque neovascularization Grade 2 had significantly more often a history of CVE than subjects with intraplaque neovascularization Grade 1 (38 versus 20%, Pϭ0.031).Multivariate logistic regression analysis revealed that presence of plaque was significantly associated with CVD (odds ratio 4.7, 95% CI 1.6 to 13.8) and intraplaque neovascularization grade 2 with CVE (odds ratio 4.0, 95% CI 1.3 to 12.6). Conclusion-The presence and degree of adventitial vasa vasorum and plaque neovascularization were directly associated with CVD and CVE in a retrospective study of 147 patients undergoing contrast-enhanced carotid ultrasound. (Stroke. 2010;41:41-47.)

Current Strategies and Possible Perspectives of Ultrasonic Risk Stratification of Ischemic Stroke in Internal Carotid Artery Disease

“…Systematic histopathological validation revealed a direct positive correlation between contrast enhancement using this semi-quantitative grading scale and histology [44,45]. Furthermore, wholly consistent with the concept that more vulner- able plaque contains a higher degree of neovascularization, recent retrospective studies revealed the association between plaque enhancement on contrast-enhanced ultrasound imaging and clinical symptoms including cerebrovascular events in patients with carotid atherosclerosis [19,46,47]. Therefore, contrast-enhanced ultrasound examination of the carotid artery may provide a novel, noninvasive clinical tool to identify and quantify the presence and the extent of arterial plaque neovascularization in patients at risk for developing symptomatic atherosclerosis, thus permitting more reliable assessment of cardiovascular risk.…”

“…Shah et al used a semi-quantitative grading scale (grade 0 = no neovascularization, grade 1 = limited neovascularization, grade 2 = moderate neovascularization, grade 3 = pulsating, arterial vessel) to provide a distinction between the variations observed in intraplaque neovascularization [44]. Using a similar, dichotomous grading system, various recent studies categorized contrast-enhanced ultrasound enhancement as no contrast effect (grade 1) or high (grade 2) based on the visual detection of the contrast effect within the plaque [46]. Systematic histopathological validation revealed a direct positive correlation between contrast enhancement using this semi-quantitative grading scale and histology [44,45].…”

Improved plaque neovascularization following 2-year atorvastatin therapy based on contrast-enhanced ultrasonography: A pilot study

“…Plaque inflammation and neovascularization are histological markers of vulnerable plaques and predictors of unstable atherosclerotic lesions in patients with cerebro-or cardiovascular disease (17). This has led to increasing interest in the inflammatory and histological processes that occur in atherosclerotic lesions and give rise to cerebrovascular events (34,35).…”

“…It combines the high spatial and temporal (15). CEUS reveals plaque biological activity and vascularization in vivo and a number of studies have suggested that CEUS may be useful for plaque risk stratification and assessing atherosclerosis progression and regression (13,16,17). However, to the best of our knowledge, no studies have directly compared the effectiveness of CEUS with standard ultrasonography for assessing plaque neovascularization in patients at risk of atherosclerosis.…”

Ultrasound in Abdominal Aortic Aneurysm

“…(Anderson et al, 2011;Lindner et al, 2000 ;ten Kate et al, 2010). Staub et al (2010a) demonstrated that adventitial vasa vasorum and plaque neovascularization of the carotid artery correlated with cardiovascular disease and past cardiovascular events using contrast-enhanced ultrasound in a retrospective study of 147 patients. Neovascularization or angiogenesis is also found in relation to AAA (Herron et al, 1991;Holmes et al, 1995;Thompson et al, 1996).…”