Imaging biomarkers of vulnerable carotid plaques for stroke risk prediction and their potential clinical implications

Saba, Luca; Saam, Tobias; Jäger, Hans Rolf; Yuan, Chun; Hatsukami, Thomas S.; Saloner, David; Wasserman, Bruce A.; Bonati, Leo H.; Wintermark, Max

doi:10.1016/s1474-4422(19)30035-3

Cited by 338 publications

(308 citation statements)

References 115 publications

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“…They emphasized that the presence and severity of clinical events were significantly associated with thrombosis and cap inflammation in ruptured plaques. Several features of carotid plaque vulnerability detected by imaging techniques could predict the risk of stroke occurrence and could be useful for stroke risk stratification, including intraplaque hemorrhage, lipid-rich necrotic core, thin or ruptured fibrous cap, plaque inflammation, intraplaque neovascularization, plaque volume, and irregular morphology of the luminal surface 8. However, vessel wall imaging techniques, such as HR-MRI VWI and intravascular ultrasound, may miss subtle lesions with resolutions in the millimeter range.…”

Section: Discussionmentioning

confidence: 99%

“…The role of angioplasty and stenting based on the stenosis diameter in the intracranial artery is unclear 4–7. A previous study showed that the stroke recurrence risk is associated with features of vulnerable plaque rather than the diameter of the stenosis 8. Plaque vulnerability characteristics combined with a degree of stenosis may help in the selection of high-risk patients for medical therapy and necessary revascularization.…”

Section: Introductionmentioning

confidence: 99%

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Optical coherence tomography evaluation of vertebrobasilar artery stenosis: case series and literature review

et al. 2020

J NeuroIntervent Surg

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BackgroundIntracranial vertebrobasilar artery stenosis is an important cause of ischemic stroke. With its high resolution, intravascular optical coherence tomography (OCT) provides detailed assessment of vessel wall features. It is widely applied to identify high-risk plaque in the cardiovascular system, but its use in the intracranial artery has been limited.ObjectiveTo explore, in this pilot study, the usefulness of OCT in imaging of the intracranial artery wall.MethodsBetween November 2017 and July 2018, four patients with severe intracranial vertebrobasilar artery stenosis were enrolled for preintervention OCT evaluation of the lesion artery. Stenosis was present in the basilar artery in one case and in the intracranial vertebral artery in three cases.ResultsOCT images of the lesions showed various features of plaque vulnerability, such as intraluminal thrombus, lipid-rich plaque with plaque rupture, thin fibrous cap, macrophage accumulations, and a mixed lesion with dissecting aneurysm. In view of the OCT findings, all patients received balloon angioplasty and stent implantation.ConclusionsThese cases describe the successful implementation of OCT in intracranial vertebrobasilar artery stenosis. No side effects were seen during the OCT imaging. This technology may help in the diagnosis and treatment of cerebrovascular disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optical coherence tomography evaluation of vertebrobasilar artery stenosis: case series and literature review

et al. 2020

J NeuroIntervent Surg

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“…Biomarkers to identify plaques at higher risk of ipsilateral stroke have been proposed with different imaging modalities, magnetic resonance imaging (MRI), ultrasound, and computed tomography angiography (CTA) (Aboyans et al, 2017;Naylor et al, 2018;Saba et al, 2019). These biomarkers are based on comparisons with the histological profiles of vulnerable plaques, determined by the presence of a ruptured fibrous cap or an intra-plaque hemorrhage for instance (Lovett et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Innovative Multiparametric Characterization of Carotid Plaque Vulnerability by Ultrasound

et al. 2020

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The degree of stenosis of a carotid plaque is a well-established risk factor for ischemic stroke. Nevertheless, the risk of ipsilateral stroke in asymptomatic carotid stenosis remains low and new imaging markers are needed to better target which patients would benefit most from endarterectomy or intensive medical therapy. Ultrafast ultrasound imaging offers parameters helping at characterizing the carotid plaque by shear wave elastography and Ultrafast Doppler (UFD). We aimed at using these techniques to characterize 3 different ultrasound biomarkers: plaque stiffness heterogeneity, wall shear stress (WSS) and intraplaque micro-flows and to correlate these biomarkers with findings on computed tomography angiography (CTA) and the pathological examination. Methods: We present the case of a multimodal evaluation of a carotid plaque using ultrasound. Elastography has been coupled to the WSS assessment and the detection of intraplaque micro-flows by UFD. The data have been compared to CTA and to the pathology examination of the tissue after carotid endarterectomy. Results: Elastography allowed at identifying stiff areas corresponding to calcifications, as well as a soft area corresponding to an intraplaque hemorrhage. The flow evaluation with UFD showed an increase of the WSS along the plaque and identified the presence of a plaque rupture, confirmed by the pathologist. Conclusion: Ultrafast ultrasound imaging is an innovative, easily accessible technique that provides imaging modalities on top of the conventional B-mode. Ultrafast ultrasound biomarkers such as plaque stiffness heterogeneity, WSS and intraplaque micro-flows could help to define the vulnerability of the carotid plaque in order to stratify patients that could benefit most from endarterectomy or intensive medical therapy.

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“…The traditional concept of using the degree of luminal stenosis as the sole imaging marker for the selection of the optimal therapeutic approach is challenged by a rapidly growing body of literature demonstrating that plaques causing only mild stenosis may still lead to stroke. 6,7 Moreover, it is important to underline that plaque composition may change dramatically over a few years and cardiovascular risk factors play a major role in these changes. 8 Physicians treating patients with carotid disease should be aware of this paradigm shift since nowadays the imaging of vulnerable plaques and their characterization plays a key role towards the improvement of risk strat-…”

Section: Introductionmentioning

confidence: 99%

CT and MR Imaging of Carotid Wall and Plaque

Saba

Mannelli

Balestrieri

et al. 2019

J Neurosonol Neuroimag

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Imaging of the carotid artery wall is the focus of several ongoing research studies that are investigating the optimal approach to identify so-called "vulnerable plaques". Even when standard arterial luminal imaging fails to indicate a stenosis in stroke patients, a non-stenotic plaque may be responsible for the stroke. Indeed, over the past decade there has been a paradigm shift in the diagnosis and risk stratification of patients with carotid artery disease, whereby nowadays more emphasis is put on plaque characterization, mainly by using computed tomography (CT) and magnetic resonance (MR), in addition to the usual assessment of stenosis and surface irregularities. In this review, we will discuss current state-of-the-art CT and MR techniques to characterize vulnerable plaques and summarize current developments in imaging-based assessment of carotid plaques, in order to identify ideal candidates for revascularization and to monitor the effects of medical therapy. JNN 116 http://www.j-nn.org J Neurosonol Neuroimag 2019;11(2):115-125 Luca Saba, et al. Imaging of Carotid Plaque ification and therapy selection in patients with both high-and low-degree carotid artery stenosis.and size of the lipid-rich-necrotic-core (LRNC), and active plaque inflammation. In the following sections the features linked to plaque vulnerability are presented. FIG. 4. Male patient with right hand weakness with ulceration in the (A) left internal carotid artery internal carotid artery visibile in the sagittal, (B) axial and (C) Coronal planes (white arrows).

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Imaging biomarkers of vulnerable carotid plaques for stroke risk prediction and their potential clinical implications

Cited by 338 publications

References 115 publications

Optical coherence tomography evaluation of vertebrobasilar artery stenosis: case series and literature review

Optical coherence tomography evaluation of vertebrobasilar artery stenosis: case series and literature review

Innovative Multiparametric Characterization of Carotid Plaque Vulnerability by Ultrasound

CT and MR Imaging of Carotid Wall and Plaque

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