Abstract:myocardial infarction, revascularization, or death because of cardiovascular reasons). Methods-In total, 349 at-risk subjects provided written informed consent to carotid 3-dimensional ultrasound and were analyzed for ulcerations. Ulcer volume was defined as a distinct discontinuity in an atherosclerotic plaque, with a volume ≥1.00 mm 3 as measured using manual segmentation. The sum of the volumes of all ulcers seen in both carotids was the total ulcer volume. Participants were monitored for ≤5 years for outco… Show more
“…16,52 Plaque ulceration on any imaging technique is strongly associated with ischemic strokes, with hazard ratios ranging from 1.2 to 7.7. [53][54][55][56][57][58] CTA can accurately differentiate smooth, irregular, and ulcerated surfaces and can detect ulceration with high accuracy (specificity, 99%; sensitivity, 94%). 59 Plaque ulceration on CT is described somewhat variably across studies but, in general, involves extension of contrast material beyond the vascular lumen of the plaque, usually of at least 1 mm.…”
Vessel wall imaging has been increasingly used to characterize plaque beyond luminal narrowing to identify patients who may be at the highest risk of cerebrovascular ischemia. Although detailed plaque information can be obtained from many imaging modalities, CTA is particularly appealing for carotid plaque imaging due to its relatively low cost, wide availability, operator independence, and ability to discern high-risk features. The present Review Article describes the current understanding of plaque characteristics on CTA by describing commonly encountered plaque features, including calcified and soft plaque, surface irregularities, neovascularization, and inflammation. The goal of this Review Article was to provide a more robust understanding of clinically relevant plaque features detectable on routine CTA of the carotid arteries.
“…16,52 Plaque ulceration on any imaging technique is strongly associated with ischemic strokes, with hazard ratios ranging from 1.2 to 7.7. [53][54][55][56][57][58] CTA can accurately differentiate smooth, irregular, and ulcerated surfaces and can detect ulceration with high accuracy (specificity, 99%; sensitivity, 94%). 59 Plaque ulceration on CT is described somewhat variably across studies but, in general, involves extension of contrast material beyond the vascular lumen of the plaque, usually of at least 1 mm.…”
Vessel wall imaging has been increasingly used to characterize plaque beyond luminal narrowing to identify patients who may be at the highest risk of cerebrovascular ischemia. Although detailed plaque information can be obtained from many imaging modalities, CTA is particularly appealing for carotid plaque imaging due to its relatively low cost, wide availability, operator independence, and ability to discern high-risk features. The present Review Article describes the current understanding of plaque characteristics on CTA by describing commonly encountered plaque features, including calcified and soft plaque, surface irregularities, neovascularization, and inflammation. The goal of this Review Article was to provide a more robust understanding of clinically relevant plaque features detectable on routine CTA of the carotid arteries.
“…On CEUS, which is virtually an angiographic technique, the ulcer definition requires the interruption of the plaque-lumen border for at least 1 × 1 mm [13]. When it comes to 3D US, the volume criterion of a cavity measuring at least 1 mm 3 has been used [19]. Fig.…”
Carotid atherosclerotic disease constitutes a major modern health problem whose diagnosis primarily relies on imaging. Grading of stenosis has been long used as the main factor for risk stratification and guiding of management. Nevertheless, increasing evidence has shown that additional plaque characteristics such as plaque composition and surface morphology play an important role in the occurrence of symptoms, justifying the term “vulnerable plaque”. Carotid plaque surface characteristics either in the form of surface irregularities or ulceration represent an important factor of vulnerability and are associated with the occurrence of neurologic symptoms. The delineation of the carotid plaque surface can be performed with virtually all imaging modalities including ultrasound, contrast-enhanced ultrasound, multi-detector computed tomography angiography, magnetic resonance angiography and the traditional reference method of angiography. These techniques have shown varying levels of diagnostic accuracy for the identification of ulcerated carotid plaques or plaque surface irregularities. As a consequence and given its high clinical significance, radiologists should be familiar with the various aspects of this entity, including its definition, classification, imaging findings on different imaging modalities and associations. The purpose of this review is to present the current literature regarding carotid plaque ulcerations and present illustrative images of ulcerated carotid plaques.Teaching Points
• Plaque surface and ulceration represent risk factors for stroke in carotid disease.
• Characterisation of the plaque surface and ulcerations can be performed with every modality.
• US is the first-line modality for carotid disease and identification of ulcerations.
• The administration of microbubbles increases US accuracy for diagnosis of carotid ulceration.
• MDCTA and MRA are valuable for diagnosing ulceration and evaluating plaque composition.
“…Magnetic resonance imaging, 38,39) ultrasound, [40][41][42][43][44][45][46][47][48][49] transcranial Doppler, 13,49,50) and computed tomography of the head 51) have revealed findings suggestive of unstable plaque. A number of imaging parameters may be predictive of increased risk of stroke, but none of these factors have been independently validated.…”
SummaryMedical treatment for asymptomatic carotid artery stenosis (ACAS) has advanced recently. The outcomes of medical treatment and surgical treatment were evaluated to clarify the optimal treatment for ACAS.Patients with ACAS of ≥ 50% luminal narrowing underwent serial follow-up carotid artery ultrasonography for one year or more at the Center for Cardiovascular Disease Prevention between November 2006 and October 2013. The incidence of cardiovascular events (stroke, myocardial infarction, cardiovascular death) was examined in 64 patients (medical treatment group), and in 47 patients (surgical group) who underwent surgical treatment (carotid endarterectomy or carotid artery stenting) during this same period at the Department of Neurosurgery.Annual cardiovascular event rate was 0.91% (2/219 person-year) in the group of guideline-oriented medical treatment with an annual check-up for disease management and 5.6% (6/107 person-year) in the surgical group (log-rank P = 0.027; HR in the medical treatment group, 0.19 [medical treatment/surgical]; 95% confidence interval [CI], 0.028 to 0.87). Annual stroke event rate was 0.46% (1/219 person-year) in the medical treatment group and 4.7% (5/107 personyear) in the surgical group (log-rank P = 0.016; HR in the medical treatment group, 0.11 [medical treatment/surgical]; 95% CI, 0.0057 to 0.70). Multivariate logistic analysis showed that the surgical group was an independent variable associated with cardiovascular events (P = 0.049).Annual cardiovascular and stroke event rates were low in patients receiving medical treatment for ACAS and better than surgical treatment. The present study shows that medical treatment is an important option for ACAS. (Int Heart J 2016; 57: 80-86)
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