Vulnerable Atherosclerotic Carotid Plaque Evaluation by Ultrasound, Computed Tomography Angiography, and Magnetic Resonance Imaging: An Overview

Abstract

Ischemic syndromes associated with carotid atherosclerotic disease are often related to plaque rupture. The benefit of endarterectomy for high-grade carotid stenosis in symptomatic patients has been established. However, in asymptomatic patients, the benefit of endarterectomy remains equivocal. Current research seeks to risk stratify asymptomatic patients by characterizing vulnerable, rupture-prone atherosclerotic plaques. Plaque composition, biology, and biomechanics are studied by noninvasive imaging techniques such as magnetic resonance imaging, computed tomography, ultrasound, and ultrasound elastography. These techniques are at a developmental stage and have yet to be used in clinical practice. This review will describe noninvasive techniques in ultrasound, magnetic resonance imaging, and computed tomography imaging modalities used to characterize atherosclerotic plaque, and will discuss their potential clinical applications, benefits, and drawbacks.

High expression of CX3C chemokine receptor 1 (CX3CR1) in human carotid plaques is associated with vulnerability of the lesions

“…Based on this, we hypothesize that fractalkine promotes foam cells accumulation and lipid-necrotic core formation similarly to what has been reported in animal models [5]. A close connection between high CX3CR1 levels and large lipid core, as well as active inflammation and destruction of plaque fibrous elements, are considered major criteria for plaque vulnerability, emphasizing the role of fractalkine in carotid lesion destabilization [1,18].…”

“…Generally, non-calcified/low calcified plaques are treated as high risk lesions because they are associated more with cerebrovascular events than calcified lesions [18][19][20]22]. We also observed (data not shown) that less calcified plaques were significantly more frequent symptomatic than lesions with enlarged calcification.…”

“…It is unclear whether it is involved in the vulnerability of human carotid plaques. By definition, vulnerable plaques are unstable lesions, prone to rupture, and susceptible to thrombosis [18,20,22].…”

Early Detection System of Vascular Disease and Its Application Prospect

“…Although CIMT did not consistently improve risk classification of individuals, the study found that CIMT was a significant and independent predictor of cardiovascular events [66]. High resolution multidetector row computed tomography angiography (CTA) can accurately assess plaque composition due to its advantages of rapid examination, relatively low cost, and being capable of measuring the absolute density as well as accurate identification and quantification of calcification, but for the identification of lipid core and plaque bleeding there is still lack of specificity [67]. High resolution magnetic resonance imaging (MRI) can describe the characteristics of carotid artery plaque, identify and measure plaque composition (lipid rich core, fibrous cap thickness, plaque bleeding and calcification, etc.…”

“…Compared with other imaging techniques, MRI has very high sensitivity and specificity for the identification and detection of plaque composition. However, the high cost, more contraindications, limited availability, and checking for a long time of MRI made it unable to realize the purpose of screening [67]. …”