Assessment of the common carotid artery wall stiffness by Shear Wave Elastography in Behcet’s disease

Abstract

Aim: To evaluate endothelial dysfunction and subclinical atherosclerosis in Behcet’s disease (BD) by measuring the common carotid artery (CCA) wall stiffness and carotid intima-media thickness (CIMT).Materials and methods: We prospectively evaluated CIMT and the CCA wall stiffness of 34 BD patients and 28 age/sex-matched controls. CIMT measurements were performed from the posterior wall of the carotid artery approximately 10 mm proximal to the initiation of the carotid bulb using B-mode ultrasound. The stiffness of the CCA was measured from the superficial wall of the CCA using shear wave elastography (SWE). SWE measurements were recorded as shear wave velocity (SWV) using m/s as a unit.Results: The mean right (0.5±0.11 mm) and left (0.5±0.14 mm) CIMT of the patients were significantly higher compared to the mean right (0.41±0.07 mm) and left (0.41±0.11 mm) CIMT of the healthy controls (p=0.001 and p= 0.003 respectively). The mean right (3.72±0.94 m/s) and left (3.57±0.72 m/s) CCA wall stiffness of the patients were significantly higher compared to the mean right (2.42±0.49 m/s) and left (2.56±0.49 m/s) CCA wall stiffness of the controls (p<0.001 for both).Conclusions: SWE seems to be a promising modality to evaluate endothelial dysfunction in BD by interpreting the arterial stiffness, and SWE might be an important adjunct to clinical and laboratory findings, and imaging modalities to assess cardiovascular risk in BD. Moreover, SWE evaluation of the arterial stiffness might assist us to understand pathophysiological aspects of BD.

Vascular Shear Wave Elastography in Atherosclerotic Arteries: A Systematic Review

“…First, by the use of different US machines as acquisition and post-processing properties differ with the machine. Alis et al (2018) reported considerably lower stiffness values in the arterial wall than the other studies. They used a Toshiba Aplio 500 machine that does not have a specific carotid artery mode.…”

“…This difference disappeared when both groups were compared at similar blood pressures (Marais et al 2019). Behçet's disease (Alis et al 2018) was, independent of blood pressure, associated with a higher SWV compared with controls. In addition, stiffness values positively correlated with patient characteristics (i.e., age, systolic blood pressure and low-density lipoprotein) in patients with hypertension (Marais et al 2019) and ischemic stroke (Maksuti et al 2016).…”

“…All studies scored an unknown or high risk of bias in at least one category. Seven studies (Ramnarine et al 2014b;Garrard et al 2015;Li et al 2016;Zhang et al 2016;Alis et al 2018;Shang et al 2018;Marlevi et al 2020) did not report whether they included patients randomly or consecutively, and one study reported they did not (Marais et al 2019). In addition, most studies (Li et al 2016;Zhang et al 2016;Lou et al 2017;Marais et al 2019) did not report whether the index test was interpreted without knowledge of the reference standard and vice versa.…”

“…The 10 studies on SWE in human carotid arteries (Ramnarine et al 2014b;Garrard et al 2015;Maksuti et al 2016;Zhang et al 2016;Lou et al 2017;Alis et al 2018;Di Leo et al 2018;Shang et al 2018;Marais et al 2019;Marlevi et al 2020) were performed with varying numbers of patients, that is, 22 (Marlevi et al 2020) to 199 (Zhang et al 2016); different diseases affecting the arterial wall, that is, Behçets disease (Alis et al 2018) and hypertension (Marais et al 2019); and different stages of atherosclerotic disease, that is, atherosclerotic plaques (Ramnarine et al 2014b;Zhang et al 2016;Lou et al 2017;Marlevi et al 2020), symptomatic patients with a CEA scheduled (Garrard et al 2015;Di Leo et al 2018) or without a CEA scheduled (Maksuti et al 2016;Shang et al 2018); and different methods of comparison, that is, pulse wave velocity (PWV) (Maksuti et al 2016;Marais et al 2019) and/or healthy controls (Ramnarine et al 2014b;Maksuti et al 2016;Alis et al 2018;Marais et al 2019) in the arterial wall, and plaque echogenicity (GSM) (Garrard et al 2015;Zhang et al 2016;Lou et al 2017;Shang et al 2018) Because not all patient groups present with atherosclerotic plaques, three studies solely investigated the carotid arterial wall (Maksuti et al 2016;Alis et al 2018;Marais et al 2019). Only one study...…”

Neuroinflammation and Precision Medicine in Pediatric Neurocritical Care: Multi-Modal Monitoring of Immunometabolic Dysfunction

“…When present, inflammation causes endothelial damage, thereby altering the vessel wall architecture, resulting in stiff vessels with a loss in vascular reactivity and as a consequence, impairment in cerebral auto-regulatory capacity. Elastography has the ability to measure such changes and has been used in inflammatory conditions such as Bechet's disease to demonstrate early subclinical vasculitis as suggested by greater vessel stiffness [59]. These early findings may serve to identify subclinical measures of pathologic inflammation sooner, thereby enhancing clinical detection and providing targets for earlier intervention, and prevention of secondary complications.…”