Abstract 3288: Contrast-enhanced Carotid Ultrasound For The Quantitative Evaluation Of Neovascularization In Atheroscrelotic Carotid Artery Plaques
Background and Purpose: Contrast-enhanced ultrasound(CEUS) enables us to delineate microvessels such as neovascular in the plaques. Plaque vulnerability is associated with neovascularization, especially shoulder regions of the plaques, prone to rupture and cause ischemic events. We aimed to evaluate localization and density of intraplaque neovascularization in carotid atherosclerotic plaques quantitatively with CEUS compared with the pathological findings. Patients and
Methods: 25 consecutive patients (symptomatic:20, asymptomatic:5) undergoing carotid endarterecromy (CEA) for carotid stenoses between July 2010 and March 2011 were enrolled. Using equipment is LOGIQ E9 with a linear probe. CEUS is performed on amplitude modulation mode after a bolus injection of Sonazoid (perflubutane, GE Healthcare, Oslo, Norway). We settled the region of interests (ROIs) in the plaques, and measured the peak intensity (dB). We chose the ROIs in the shoulder and core of the plaques to compare the neovascular density (categorized as absent-sporadic:grade1, extensive:grade2) confirmed by histopathological examination in the CEA specimens that contained the intima and some parts of the media.
Results: 21 patients (4 were excluded because of calcification and ulcer) were analyzed. The contrast effect was higher in the shoulders by 6.9dB than in the cores of the plaques (p<0.05). Contrast effect had no significant difference between symptomatic and asymptomatic plaques. Histopathological examination revealed that the all plaques contained necrotic core, intraplaque hemorrhage and neovascularization in the shoulder with thinning or ruptured fibrous cap, which showed vulnerable plaques. Plaque with greater neovascularization showed higher contrast effect (grade1 vs grade 2: 4.8 dB vs. 7.4 dB, respectively, p<0.05).
Conclusion: Quantitative evaluation of the contrast effect in the plaque, especially plaque shoulder, correlated with the density of neovascular proliferation. While only neovascularization does not destabilize the atheroscrelotic plaques, quantitative evaluation using CEUS may help us to stratify plaque vulnerability .
- © 2012 by American Heart Association, Inc.