Juxtalumenal location of plaque necrosis and neoformation in symptomatic carotid stenosis

Bassiouny, Hisham S.; Sakaguchi, Yashuhiro; Mikucki, Susanne A.; McKinsey, James F.; Piano, Giancarlo; Gewertz, Bruce L.; Glagov, Seymour

doi:10.1016/s0741-5214(97)70056-9

Cited by 183 publications

(148 citation statements)

References 26 publications

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“…The risk of plaque rupture depends on plaque composition, which may be more important than plaque size (5). Other factors are also important; proximity of the necrotic core to the lumen and cellular indicators of plaque neoformation or inflammatory reaction around the fibrous cap are associated with clinical events (6). Plaque inflammation may well be an indicator of overall systemic inflammation.…”

Section: Introductionmentioning

confidence: 99%

MRI of atherosclerosis in clinical trials

et al. 2006

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Magnetic resonance imaging (MRI) of the arterial wall has emerged as a viable technology for characterizing atherosclerotic lesions in vivo, especially within carotid arteries and other large vessels. This capability has facilitated the use of carotid MRI in clinical trials to evaluate therapeutic effects on atherosclerotic lesions themselves. MRI is specifically able to characterize three important aspects of the lesion: size, composition and biological activity. Lesion size, expressed as a total wall volume, may be more sensitive than maximal vessel narrowing (stenosis) as a measure of therapeutic effects, as it reflects changes along the entire length of the lesion and accounts for vessel remodeling. Lesion composition (e.g. lipid, fibrous and calcified content) may reflect therapeutic effects that do not alter lesion size or stenosis, but cause a transition from a vulnerable plaque composition to a more stable one. Biological activity, most notably inflammation, is an emerging target for imaging that is thought to destabilize plaque and which may be a systemic marker of vulnerability. The ability of MRI to characterize each of these features in carotid atherosclerotic lesions gives it the potential, under certain circumstances, to replace traditional trials involving large numbers of subjects and hard end-points -heart attacks and strokes -with smaller, shorter trials involving imaging end-points. In this review, the state of the art in MRI of atherosclerosis is presented in terms of hardware, image acquisition protocols and post-processing. Also, the results of validation studies for measuring lesion size, composition and inflammation will be summarized. Finally, the status of several clinical trials involving MRI of atherosclerosis will be reviewed.

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Section: Introductionmentioning

confidence: 99%

MRI of atherosclerosis in clinical trials

et al. 2006

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“…It has been documented that plaque is prone to rupture when the thickness of fibrous cap becomes Ͻ0.2 mm. 25 Therefore, our method may prove useful in discriminating vulnerable plaque in atherosclerotic lesion.…”

Section: Accuracy Of the Present Color Mapping Techniquementioning

confidence: 95%

Detection of Fibrous Cap in Atherosclerotic Plaque by Intravascular Ultrasound by Use of Color Mapping of Angle-Dependent Echo-Intensity Variation

et al. 2001

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Background-The thickness of the fibrous cap is a major determinant in the vulnerability of atherosclerotic plaque to rupture. It has been demonstrated that intravascular ultrasound (IVUS) backscatter from fibrous tissue is strongly dependent on the ultrasound beam angle of incidence. This study investigated the feasibility of using a new IVUS color mapping technique representing the angle-dependent echo-intensity variation to determine the thickness of the fibrous cap in atherosclerotic plaque. Methods and Results-Nineteen formalin-fixed noncalcified human atherosclerotic plaques from necropsy were imaged in vitro with a 30-MHz IVUS catheter. The IVUS catheter was moved coaxially relative to the plaque. The images showing maximum and minimum echo intensity of the plaque surface were selected to calculate the angle-dependent echo-intensity variation. A colorized representation of the echo-intensity variation in the plaque was obtained from the 2 IVUS images. A clearly bordered area with large variation in echo intensity was revealed for each plaque surface in the colorized IVUS image. The thickness (x, mm) of this area correlated significantly with that of fibrous cap (y, mm) measured from histologically prepared sections as yϭ1.05xϪ0. 01 (rϭ0.81, PϽ0.0001). Bland-Altman analysis also supported the reliability of this method (mean difference, 0.00Ϯ0.10 mm). Conclusions-This novel technique for color mapping the echo-intensity variation in IVUS provided an accurate representation of the thickness of the fibrous cap in atherosclerotic plaque. This method may be useful in assessing plaque vulnerability to rupture in atherosclerosis.

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“…Unstable plaques usually have a thin fibrous cap with a necrotic core situated near the surface. The position of the core and the local thinning of the cap may therefore predispose to rupture which then exposes the thrombogenic atheroma to circulating blood, thus initiating thrombus formation that may lead to thromboembolism and subsequent ischaemic stroke [6,7].…”

Section: Duplex Ultrasound a Useful Tool To Assess Carotid Plaque Chmentioning

confidence: 99%

Ultrasound assessment of carotid plaques over time

2012

Swiss Arch Neurol Psychiatr

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Juxtalumenal location of plaque necrosis and neoformation in symptomatic carotid stenosis

Cited by 183 publications

References 26 publications

MRI of atherosclerosis in clinical trials

MRI of atherosclerosis in clinical trials

Detection of Fibrous Cap in Atherosclerotic Plaque by Intravascular Ultrasound by Use of Color Mapping of Angle-Dependent Echo-Intensity Variation

Ultrasound assessment of carotid plaques over time

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