Contrast-Enhanced Ultrasound Imaging of the Vasa Vasorum

Staub, Daniel; Schinkel, Arend F. L.; Coll, Blai; Coli, Stefano; Steen, Antonius F.W. van der; Reed, Jess D.; Krueger, Christian G.; Thomenius, Kai E.; Adam, Dan; Sijbrands, Eric J.G.; Cate, Folkert J. ten; Feinstein, Steven B.

doi:10.1016/j.jcmg.2010.02.007

Cited by 157 publications

(45 citation statements)

References 67 publications

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“…As initially reported by Feinstein et al in 2004, ultrasound contrast agents revealed real-time visualization of the carotid artery adventitial VV network in patients undergoing routine carotid ultrasonography [58,59]. Several independent reports using similar techniques confirmed the initial discoveries including the observations that adventitial VV and intra-plaque angiogenesis can be visualized [60][61][62][63][64][65][66][67][68][69].…”

Section: Non-invasive Vasa Vasorum Imagingmentioning

confidence: 53%

Vascular ultrasound for atherosclerosis imaging

2011

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Cardiovascular disease is a leading cause of death in the Western world. Therefore, detection and quantification of atherosclerotic disease is of paramount importance to monitor treatment and possible prevention of acute events. Vascular ultrasound is an excellent technique to assess the geometry of vessel walls and plaques. The high temporal as well as spatial resolution allows quantification of luminal area and plaque size and volume. While carotid arteries can be imaged non-invasively, scanning of coronary arteries requires invasive intravascular catheters. Both techniques have already demonstrated their clinical applicability. Using linear array technology , detection of disease as well as monitoring of pharmaceutical treatment in carotid arteries are feasible. Data acquired with intravascular ultrasound catheters have proved to be especially beneficial in understanding the development of atherosclerotic disease in coronary arteries. With the introduction of vascular elastography not only the geometry of plaques but also the risk for rupture of plaques might be identified. These so-called vulnerable plaques are frequently not flow-limiting and rupture of these plaques is responsible for the majority of cerebral and cardiac ischaemic events. Intravascular ultrasound elastography studies have demonstrated a high correlation between high strain and vulnerable plaque features, both ex vivo and in vivo. Additionally, pharmaceutical intervention could be monitored using this technique. Non-invasive vascular elastography has recently been developed for carotid applications by using compound scanning. Validation and initial clinical evaluation is currently being performed. Since abundance of vasa vasorum (VV) is correlated with vulnerable plaque development, quantification of VV might be a unique tool to even prevent this from happening. Using ultrasound contrast agents, it has been demonstrated that VV can be identified and quantified. Although far from routine clinical application, non-invasive and intravascular ultrasound VV imaging might pave the road to prevent atherosclerotic disease in an early phase. This paper reviews the conventional vascular ultrasound techniques as well as vascular ultrasound strain and vascular ultrasound VV imaging.

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Section: Non-invasive Vasa Vasorum Imagingmentioning

confidence: 53%

Vascular ultrasound for atherosclerosis imaging

2011

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“…Such changes were found in animal models, autopsy studies, and clinical reports and indicate that an increase in new microvessels also increases the development of rupture-prone atheroma. Interestingly, intraplaque hemorrhage, which has gained considerable significance as a parameter of vulnerable plaques, seems to result from the development of leaky neointimal vessels [18]. …”

Section: Plaque Morphologymentioning

confidence: 99%

“…b A spot-like increase in echogenicity within the plaque becomes visible due to transition of the vasa vasorum by the microbubbles of the contrast agent (arrows). Reproduced as a modified figure with permission from Staub et al [18]. …”

Section: Plaque Morphologymentioning

confidence: 99%

Carotid Plaque Hemodynamics

Harloff

2012

Intervent Neurol

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Internal carotid artery (ICA) plaques constitute one major source of retinal and cerebral brain embolism. Current guidelines recommend optimal treatment of cardiovascular risk factors and recanalization based on the degree of ICA stenosis. However, ICA plaque composition, motion, vascularization, and local hemodynamics have only received limited attention as potential and independent risk factors for plaque rupture. The European Carotid Surgery Trial (ECST) showed an increased risk of stroke recurrence even in moderate stenosis if the plaque surface was ulcerated in angiography. Further indicators of plaque instability and thus vulnerability were established by native or contrast-enhanced two-dimensional duplex ultrasound, CT, and MRI. Due to high soft tissue contrast, multi-contrast MRI seems to be ideally suited to identify plaque compositions that are prone to rupture, although data from large clinical trials proving the independent predictive value of plaque morphology are lacking. The role of cardiovascular risk factors for atherosclerosis of the common carotid artery is well established. Nevertheless, little is known concerning the impact of local hemodynamics on plaque development, progression, and rupture. Wall shear stress, the friction force acting on the endothelium of the vessel wall, was shown to be able to induce local atherosclerosis and vulnerable plaques in animal models. Plaque movement and deformation was limited to investigations using ultrasound in order to identify plaques at risk. Similarly, models to calculate tensile plaque stress seem to be able to identify peak mechanical stress acting on plaque surfaces that make such regions susceptible to rupture. In this review, current evidence regarding the correlation of plaque location, composition, and local hemodynamics at the carotid artery bifurcation will be presented. Moreover, the potential benefit of a future comprehensive and individual risk assessment will be discussed.

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“…Reliable detection and quantification of microcirculation using CEUS constitute an important clinical goal and a major issue confronting the future development of CEUS (Staub et al 2010). Pseudoenhancement in tissue signals caused by non-linear propagation is seen frequently in both superficial and deep tissue imaging and is a hindrance to reliable assessment and quantification of microcirculation.…”

Section: Discussionmentioning

confidence: 99%