Assessment of carotid plaque neovascularization using quantitative analysis of contrast-enhanced ultrasound imaging is useful for risk stratification in patients with coronary artery disease

Nakamura, Jun; Nakamura, Takamitsu; Deyama, Juntaro; Fujioka, Daisuke; Kawabata, Ken‐ichi; Obata, Jun–ei; Watanabe, Kazuhiro; Watanabe, Y.; Kugiyama, Kiyotaka

doi:10.1016/j.ijcard.2015.05.107

Cited by 29 publications

(21 citation statements)

References 31 publications

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“…The results of the diagnostic methods were recorded, and neovascularization in carotid plaques was divided according to the grading criteria of Nakamura et al (11): Grade 0, no obvious micro-bubbles in plaques; Grade I, micro-bubbles were limited to one side of the shoulder or outer membrane of plaques; Grade II, visible diffuse micro-bubbles in plaques.…”

Section: Methodsmentioning

confidence: 99%

Comparison of diagnostic values of ultrasound micro-flow imaging and contrast-enhanced ultrasound for neovascularization in carotid plaques

Zhang

Wang

et al. 2017

Experimental and Therapeutic Medicine

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The aim of the present study was to compare the diagnostic values of ultrasound micro-flow imaging (SMI) and contrast-enhanced ultrasound (CEUS) for neovascularization in carotid plaques, and to investigate their capacities for predicting the risks of cerebral stroke. A total of 39 patients (64 carotid plaques) with severe carotid artery stenosis undergoing carotid endarterectomy were selected between February 2015 and February 2016, and SMI and CEUS were used to detect neovascularization in plaques. According to the CEUS dynamic graph of plaques, the enhanced intensity visual scales and contrast parameters were obtained. Carotid atherosclerotic plaques were divided into 4 groups. The differences in the enhanced intensity visual scales, contrast parameters, and gray-scale median (GSM) values among the 4 groups were analyzed. Carotid plaque tissue samples from patients were stained for CD34, and the consistency of the methods for the diagnosis of neovascularization in plaques was analyzed. The differences in GSM values, enhanced intensities, and enhanced densities among the 4 groups of plaques were statistically significant (F=29.365, χ2=29.025, χ2=30.871, P<0.001); the differences in enhanced intensities of carotid atherosclerotic plaques with different echo types were statistically significant (χ2=17.951, P<0.001). The enhanced intensity of plaques was negatively correlated with the GSM value (r=−0.376, P<0.01), and the enhanced density of plaques was negatively correlated with the GSM value (r=−0.252, P<0.01). SMI and CEUS grading had good consistency (κ=0.860>0), there were statistically significant differences in new vessel densities with different SMI gradings (P<0.001), and the clinical symptoms and severity were positively correlated with SMI grading (rs=0.592>0). In conclusion, SMI and CEUS have good consistency for evaluating neovascularization in carotid plaques, and have good clinical value for evaluating neovascularization in carotid plaques.

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Section: Methodsmentioning

confidence: 99%

Comparison of diagnostic values of ultrasound micro-flow imaging and contrast-enhanced ultrasound for neovascularization in carotid plaques

Zhang

Wang

et al. 2017

Experimental and Therapeutic Medicine

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“…The higher low‐density lipoprotein cholesterol level in the ACS group than in the stable CAD group and the elevated blood cholesterol level gradually promoted the formation of a plaque lipid core as well as plaque neovascularization due to the division and proliferation of vascular endothelial cells . Neovascularization promoted the growth of plaques, and internal hemorrhage and inflammation resulted from the incomplete endothelial structure and insufficient pericytes and smooth muscle cells of neovascularization, in addition to the increased permeability and fragility of neovascularization . Followed by the formation and accelerated damage of unstable plaques, rupture and hemorrhage of unstable plaques finally occurred and led to cardiovascular diseases…”

Section: Discussionmentioning

confidence: 99%

“…Interobserver Variability of Enhancement Intensity and Ratio on Contrast-Enhanced US Values are expressed as mean 6 SD where applicable. Qin et al-Carotid Plaque Neovascularization on Contrast-Enhanced USinsufficient pericytes and smooth muscle cells of neovascularization, in addition to the increased permeability and fragility of neovascularization 30,31. Followed by the formation and accelerated damage of unstable plaques, rupture and hemorrhage of unstable plaques finally occurred and led to cardiovascular diseases 32.…”

mentioning

confidence: 99%

Evaluation of Carotid Plaque Neovascularization in Patients With Coronary Heart Disease on Contrast‐Enhanced Ultrasonography

Qin

Zhang

Wang

et al. 2017

J of Ultrasound Medicine

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“…Together with past manifestations of ACS, carotid atherosclerosis is thought to reflect a subsequent worsening of CAD and considered a risk factor for CAD. 5,6,14,15 The grade of CECP could be helpful to predict future CV events, irrespectively of its dot or extensive uptake pattern. 14 A semi-quantitative assessment method can be more accessible than a time-consuming quantitative technique.…”

Section: Prognosis Of Contrast-enhancement Of Carotid Plaque For CLmentioning

confidence: 99%

“…Therefore, diffuse grade 2 CECP, as in this study, seems to be sufficient to predict CV prognosis in clinical practice. 15 Considering the good correlation between plaque histologic vulnerability and CECP, 1 the occurrence of ACS could be related with plaque or IMT neovascularization. In particular, a diffuse grade of CECP can be useful for the risk stratification for clinical outcomes in all study patients, although the relationship between ACS or stroke events and CECP grade did not reach the signification level.…”

Section: Prognosis Of Contrast-enhancement Of Carotid Plaque For CLmentioning

confidence: 99%

Implication of ultrasound contrast‐enhancement of carotid plaques in prevalence of acute coronary syndrome and occurrence of cardiovascular outcomes

Choi

Kim

et al. 2018

J of Clinical Ultrasound

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Purpose: Ultrasonographic contrast enhancement of carotid plaque (CECP) has been used to detect neovascularization of vasa vasorum and plaque. However, it is uncertain whether CECP can provide risk stratification of coronary artery disease (CAD). This study aimed to evaluate the relationship between CECP and manifestations of acute coronary syndrome (ACS) in established CAD patients and to explore the prognostic implication of CECP for cardiovascular (CV) clinical outcomes.Methods: A medical record review revealed that contrast-enhanced ultrasonography was performed to evaluate carotid atherosclerosis in 209 coronary artery-stented and 105 non-stented patients. The rate of ACS manifestations was compared depending on contrast uptake patterns: grade 0, absent; grade 1, dot; and grade 2, diffuse pattern. CV primary outcomes were assessed during a mean 7.6 months of follow-up.Results: Male sex, smoking, history of old myocardial infarction, intensive medications, and a favorable lipid profile were common in the stented versus non-stented group. Patients with grade 2 CECP had a higher rate of ACS, greater plaque thickness, and class I-II of Gray-Weale plaque echogenicity. During follow-up, 10 coronary revascularizations (nine ACSs), six strokes, and four heart failures occurred. Grade 2 CECP was more closely related with CV primary outcomes and showed a tendency toward more acute CV outcomes.Conclusion: ACS manifestations were proportionate to CECP grade. Diffuse CECP uptake could be a risk factor for acute CV outcomes. K E Y W O R D S acute coronary syndrome, carotid plaque, contrast-enhanced ultrasonography 1 | INTRODUCTION Contrast-enhanced ultrasonography (CEU) can not only clearly depict the carotid artery and its lesions, but also demonstrate neovascularization within carotid plaque. 1-3 Despite a lack of definitive evidence, ultrasonographic contrast-enhancement of carotid plaque (CECP) appears to be a marker of plaque vulnerability as it usually results from local inflammation, hemorrhage, or dissection. 1 Similarly, contrast uptake in the vasa vasorum could provide useful information about carotid atherosclerosis in its earliest stage, 4 and CECP has been related with subclinical or clinical cardiovascular (CV) events. 5,6Plaque histology has shown that the degree of CECP is related with the extent of neovascularization. 1,2 Diffuse or smoky rather than dot CECP patterns would be linked with extensive or hyperemic microvascularity. In vulnerable plaques, CEU may also be used to evaluate the effects of statins. 7 However, the relationship between CECP patterns and acute coronary syndrome (ACS) or chronic stable ischemic heart disease (IHD)

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Assessment of carotid plaque neovascularization using quantitative analysis of contrast-enhanced ultrasound imaging is useful for risk stratification in patients with coronary artery disease

Cited by 29 publications

References 31 publications

Comparison of diagnostic values of ultrasound micro-flow imaging and contrast-enhanced ultrasound for neovascularization in carotid plaques

Comparison of diagnostic values of ultrasound micro-flow imaging and contrast-enhanced ultrasound for neovascularization in carotid plaques

Evaluation of Carotid Plaque Neovascularization in Patients With Coronary Heart Disease on Contrast‐Enhanced Ultrasonography

Implication of ultrasound contrast‐enhancement of carotid plaques in prevalence of acute coronary syndrome and occurrence of cardiovascular outcomes

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