Advances in Noninvasive Carotid Wall Imaging with Ultrasound: A Narrative Review

Abstract

Carotid atherosclerosis is a major cause for stroke, with significant associated disease burden morbidity and mortality in Western societies. Diagnosis, grading and follow-up of carotid atherosclerotic disease relies on imaging, specifically ultrasound (US) as the initial modality of choice. Traditionally, the degree of carotid lumen stenosis was considered the sole risk factor to predict brain ischemia. However, modern research has shown that a variety of other imaging biomarkers, such as plaque echogenicity, surface morphology, intraplaque neovascularization and vasa vasorum contribute to the risk for rupture of carotid atheromas with subsequent cerebrovascular events. Furthermore, the majority of embolic strokes of undetermined origin are probably arteriogenic and are associated with nonstenosing atheromas. Therefore, a state-of-the-art US scan of the carotid arteries should take advantage of recent technical developments and should provide detailed information about potential thrombogenic (/) and emboligenic arterial wall features. This manuscript reviews recent advances in ultrasonographic assessment of vulnerable carotid atherosclerotic plaques and highlights the fields of future development in multiparametric arterial wall imaging, in an attempt to convey the most important take-home messages for clinicians performing carotid ultrasound.

Nuclear Magnetic Resonance-Based Lipidomics in the Assessment of Cardiometabolic Risk in Type 1 Diabetes: An Exploratory Analysis

“…To overcome these limitations, the use of biomarkers has gained attention in the last few years. Thus, either imaging [30] or circulating biomarkers [31][32][33] seem promising, especially in those populations in which current tools perform rather poorly (such as T1D). In this regard, highthroughput lipidomic analysis could have the potential to unravel new pathways and biomarkers in the field of CVD in T1D.…”

Implementing Carotid Ultrasonography in Optimizing Primary Cardiovascular Prevention Strategy: Has the Time Come?

“…The prompt identification of the asymptomatic atherosclerotic lesions is crucial for the reclassification of a low/moderate CV risk patient to the category of high or very high CV risk and for the optimal implementation of an aggressive treatment strategy aiming at preventing future CV events [ 3 ]. Among various tests designed to evaluate the indices of asymptomatic target-organ damage with potential reclassification value, carotid ultrasonography has been the focus of clinical interest and intense research [ 4 , 5 ]. Carotid ultrasonography allows the assessment of both structural (atherosclerotic plaque burden) and functional (local stiffness) arterial wall properties and several indices including carotid intima-media thickness, carotid distensibility, and carotid plaque characteristics have been all associated with increased CV risk [ 4 , 5 , 6 , 7 , 8 , 9 ].…”

“…Among various tests designed to evaluate the indices of asymptomatic target-organ damage with potential reclassification value, carotid ultrasonography has been the focus of clinical interest and intense research [ 4 , 5 ]. Carotid ultrasonography allows the assessment of both structural (atherosclerotic plaque burden) and functional (local stiffness) arterial wall properties and several indices including carotid intima-media thickness, carotid distensibility, and carotid plaque characteristics have been all associated with increased CV risk [ 4 , 5 , 6 , 7 , 8 , 9 ]. However, the presence of carotid plaque appears to have the strongest prognostic value in terms of CV risk reclassification [ 4 , 8 ].…”

“…However, the presence of carotid plaque appears to have the strongest prognostic value in terms of CV risk reclassification [ 4 , 8 ]. Further improvement in risk estimation may be gained by considering not only the presence of the carotid plaque, but also other characteristics, such as plaque echogenicity and heterogeneity (intraplaque hemorrhage), surface irregularities, neovascularization, size (volume and area, total plaque score), which appear to carry additional adverse prognostic value [ 4 , 5 ].…”

Editorial: New Advances in Cerebrovascular Disorders

“…Ultrasound, with its many advantages over other imaging modalities, holds a prominent position in the study of arterial wall pathology. In a comprehensive review, Alexandratou et al summarize recent progress in the ultrasonographic assessment of vulnerable carotid atheromatic plaques and highlight the fields of future development in the evaluation of plaque echogenicity, of surface morphology, of the use of contrast-enhanced ultrasound and of elastography, in an attempt to communicate important take-home messages to clinicians [ 3 ]. In line with the previous review, Bill et al investigated a large prospective cohort of stroke patients from the Lausanne stroke registry with carotid ultrasound within a week after onset [ 4 ].…”