Innovative Multiparametric Characterization of Carotid Plaque Vulnerability by Ultrasound

Abstract

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.

Management of carotid stenosis for primary and secondary prevention of stroke: state-of-the-art 2020: a critical review

“… 11 , 12 Only the largest ulcerations, however, appear to have the highest risk. To better assess ulcer volume, 3D reconstruction, 13 microbubble contrast imaging, 14 , 15 or sensitive Doppler imaging 16 might be useful ( Figure 1 B ).…”

Prediction of Mechanosensitive Genes in Vascular Endothelial Cells Under High Wall Shear Stress

“…WSS is the frictional resistance exerted by the blood flow that acts on and parallel to the surface of the endothelium. Low WSS may promote the deposition of particles on the arterial wall and the accumulation of plaque, while high WSS not only stimulates adaptive outward remodeling but also destabilizes atherosclerotic plaques in narrowed blood vessels by directly acting on plaques, inducing inflammation, enhancing oxidative stress, and subsequently causing embolization of distal arteries ( Dolan et al, 2013 ; Chen et al, 2019 ; Goudot et al, 2020 ). The ability of blood vessels to react to changes in hemodynamic stimuli is mediated primarily by ECs, which form the internal layer of blood vessel walls.…”

The prognostic value of the serum inflammatory biomarkers in patients with carotid atherosclerosis

“…Asymptomatic carotid artery stenosis is a well-recognized risk factor for ischemic stroke and its prevalence increases with severity of degree of stenosis [19]. With stroke risk associated also ultrasound plaque features, but best treatment for asymptomatic carotid artery stenosis and prophylactic revascularization still controversial [20]. To identify subgroup of patients at higher risk for ipsilateral stroke is important aim.…”