Use of ultrasound contrast in the diagnosis of carotid artery occlusion

Ferrer, José María Escribano; Samsó, Julio; Serrando, J Royo; Valenzuela, V. Fernández; Bellmunt-Montoya, Sergi; Docampo, Manuel Matas

doi:10.1067/mva.2000.104599

Cited by 64 publications

(35 citation statements)

References 27 publications

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“…In the setting of carotid stenosis, CEUS can be used to distinguish between total carotid occlusion and high-grade stenosis, identify plaque ulceration, and evaluate carotid plaque neovascularization. 25,30,73 Specific, commercially available pulse sequences are needed to suppress signal from tissue within the image and accentuate signal from the intravascular bubbles. Quantitative methods have been established to improve reproducibility of measurements of contrast enhancement.…”

mentioning

confidence: 99%

Contemporary carotid imaging: from degree of stenosis to plaque vulnerability

Brinjikji¹,

Huston²,

Rabinstein

et al. 2016

JNS

290

172

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abbreviatioNs AHA = American Heart Association; CAS = carotid artery stenting; CEA = carotid endarterectomy; CEUS = contrast-enhanced ultrasonography; CTA = CT angiography; DCE = dynamic contrast-enhanced; DSCT = dual-source CT; FDG = fluorodeoxyglucose; FSE = fast spin echo; Gd = gadolinium; HU = Hounsfield units; IPH = intraplaque hemorrhage; LRNC = lipid-rich necrotic core; MDCT = multidetector-row CT; MDCTA = MDCT angiography; MES = microembolic signal; MMP-9 = matrix metalloproteinase-9; MRA = MR angiography; PDW = proton density-weighted; SUV = standardized uptake value; SUVmax = maximal SUV; TBR = target-to-background ratio; TCD = transcranial Doppler ultrasonography; TIA = transient ischemic attack; TOF = time of flight; USPIO = ultrasmall superparamagnetic iron oxide. Carotid artery stenosis is a well-established risk factor of ischemic stroke, contributing to up to 10%-20% of strokes or transient ischemic attacks. Many clinical trials over the last 20 years have used measurements of carotid artery stenosis as a means to risk stratify patients. However, with improvements in vascular imaging techniques such as CT angiography and MR angiography, ultrasonography, and PET/CT, it is now possible to risk stratify patients, not just on the degree of carotid artery stenosis but also on how vulnerable the plaque is to rupture, resulting in ischemic stroke. These imaging techniques are ushering in an emerging paradigm shift that allows for risk stratifications based on the presence of imaging features such as intraplaque hemorrhage (IPH), plaque ulceration, plaque neovascularity, fibrous cap thickness, and presence of a lipid-rich necrotic core (LRNC). It is important for the neurosurgeon to be aware of these new imaging techniques that allow for improved patient risk stratification and outcomes. For example, a patient with a low-grade stenosis but an ulcerated plaque may benefit more from a revascularization procedure than a patient with a stable 70% asymptomatic stenosis with a thick fibrous cap. This review summarizes the current state-of-the-art advances in carotid plaque imaging. Currently, MRI is the gold standard in carotid plaque imaging, with its high resolution and high sensitivity for identifying IPH, ulceration, LRNC, and inflammation. However, MRI is limited due to time constraints. CT also allows for high-resolution imaging and can accurately detect ulceration and calcification, but cannot reliably differentiate LRNC from IPH. PET/CT is an effective technique to identify active inflammation within the plaque, but it does not allow for assessment of anatomy, ulceration, IPH, or LRNC. Ultrasonography, with the aid of contrast enhancement, is a cost-effective technique to assess plaque morphology and characteristics, but it is limited in sensitivity and specificity for detecting LRNC, plaque hemorrhage, and ulceration compared with MRI. Also summarized is how these advanced imaging techniques are being used in clinical practice to risk stratify patients with low- and high-grade carotid artery stenosis....

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mentioning

confidence: 99%

Contemporary carotid imaging: from degree of stenosis to plaque vulnerability

Brinjikji¹,

Huston²,

Rabinstein

et al. 2016

JNS

290

172

View full text Add to dashboard Cite

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“…Among persons younger than 65 years of age, excess deaths caused by stroke occur in most racial/ethnic minority groups compared with whites (10). In NOMASS (Northern Manhattan Stroke Study), the ageadjusted incidence of first ischemic stroke per 100,000 population was 191 among blacks (95% CI 160 to 221), 149 among Hispanics (95% CI 132 to 165), and 88 (95% CI 75 to 101) among whites (11). The average annual ageadjusted overall (initial and recurrent) stroke incidence per 100,000 for those Ն20 years old was 223 for blacks, 196 for Hispanics, and 93 for whites, which represents a 2.4-fold RR for blacks and a 2-fold increase for Hispanics compared with whites (12).…”

Section: Epidemiology Of Extracranial Cerebrovascular Disease and Strokementioning

confidence: 99%

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease

Brott¹,

Halperin²,

Abbara

et al. 2011

Journal of the American College of Cardiology

286

120

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“…UCAs are helpful in detecting residual lumina when differentiating between subtotal stenosis ‘pseudo-occlusion’ (fig. 2) and occlusion of the ICA [17,19,20,21,22] as well as distal ICA pathologies like dissection or aneurysm near the skull base. Due to the intraforaminal course in the V2 segment, ultrasound examination of the extracranial vertebral arteries, whether native or contrast enhanced, succeeds only partially [6].…”

Section: Examination Of the Macrocirculation In Stroke Patientsmentioning

confidence: 99%

Ultrasound Contrast Agents in Ischemic Stroke

Seidel

Meairs²

2009

Cerebrovasc Dis

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The general indication for the use of ultrasound contrast agents in neurosonologic applications is an insufficient signal-to-noise ratio when investigating the cerebral macro- and microcirculation. Clinical problems that are often encountered in native sonography are ‘no flow, slow flow and low flow’ phenomena. In these cases, ultrasound contrast agents are used to differentiate between vessel occlusion and insufficient insonation conditions, as well as for the detection of very slow blood flow velocities and low flow volumes. Echo-contrast agents significantly increase the success rate of transcranial color duplex examinations of patients with acute cerebrovascular disease. Ultrasound contrast imaging also allows assessment of the cerebral microcirculation. There are a number of techniques available for performing perfusion studies. These generally utilize high mechanical index imaging, since until recently lower acoustic outputs were unable to detect microbubbles in the brain. New-generation microbubbles in combination with very sensitive contrast-specific ultrasound techniques now enable real-time visualization of stroke. Moreover, destruction sequences with assessment of microbubble replenishment using real-time, low mechanical index imaging are now available. This article reviews of state-of-the-art contrast-specific imaging techniques for ultrasound evaluation of acute stroke patients.

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Use of ultrasound contrast in the diagnosis of carotid artery occlusion

Abstract: The DUEE study is a potent diagnosis tool that allows the differentiation between true carotid artery occlusions and pseudo-occlusions.

Cited by 64 publications

References 27 publications

Contemporary carotid imaging: from degree of stenosis to plaque vulnerability

Contemporary carotid imaging: from degree of stenosis to plaque vulnerability

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease

Ultrasound Contrast Agents in Ischemic Stroke

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