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

Abstract

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)

Carotid intraplaque neovascularisation as a predictive factor for future vascular events in patients with mild and moderate carotid stenosis: an observational prospective study

“…Some studies have suggested that intraplaque neovascularisation is significantly related to ischaemic stroke, that carotid plaque can independently predict significant and complex CAD, and that CEUS-assessed carotid IPN is a clinically useful tool in high-risk cardiac patients. 28,33 In the present study, we demonstrated that carotid intraplaque neovascularisation using CEUS can predict not only stroke recurrence but also cardiovascular events, which may represent a systematic burden of atherosclerotic disease.…”

Assessment of Carotid Plaque Enhancement on Contrast-Enhanced Ultrasound as a Predictor for Severe Coronary Artery Disease

“…The sample size was calculated for a two-sample proportions test with study parameters: delta = –0.5080 (difference), p1 = 0.8050, p2 = 0.2970. 16 Power was set at 80%, confidence interval 95%, and α 0.05.…”

“…Doppler imaging was also performed and the following parameters were recorded: peak systolic velocity (PSV) of ICA and CCA, and carotid index was calculated using these values as PSV ICA/PSV CCA. 16 …”

“…• Doppler imaging was also performed and the following parameters were recorded: peak systolic velocity (PSV) of ICA and CCA, and carotid index was calculated using these values as PSV ICA/PSV CCA. 16 • Contrast Sonovue was prepared by mixing 25 mg of lyophilized powder in 5 mL of normal saline. • Contrast was injected at a dose of 0.8 to 1 mL intravenously by one person and at the same time, ultrasound was performed by the radiologist.…”

“…14 Previous studies conducted on this matter have compared contrast enhancement of carotid plaque (CECP) in patients having CAD to gauge its association with disease severity as well as whether it can accurately predict risk of future ACS in these patients. 15,16 In this study, we have compared symptomatic with asymptomatic individuals to evaluate whether CECP can predict disease status as well. Also, no similar research has been conducted on the Indian population…”