Identification of Carotid ‘Vulnerable Plaque’ by Contrast-enhanced Ultrasonography: Correlation with Plaque Histology, Symptoms and Cerebral Computed Tomography

• Published in: European journal of vascular and endovascular surgery 2011-02, Vol.41 (2), p.238-248
• Main Authors: Faggioli, G.L, Pini, R, Mauro, R, Pasquinelli, G, Fittipaldi, S, Freyrie, A, Serra, C, Stella, A
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Analysis of Variance; Atherosclerosis; Calcinosis - pathology; Carotid artery; Carotid Stenosis - complications; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - pathology; Carotid Stenosis - surgery; Cerebral Angiography - methods; Contrast Media; Endarterectomy, Carotid; Female; Fibrosis; Humans; Immunohistochemistry; Intracranial Embolism - diagnostic imaging; Intracranial Embolism - etiology; Ischemic Attack, Transient - diagnostic imaging; Ischemic Attack, Transient - etiology; Italy; Lipids - analysis; Male; Microbubbles; Neovascularization, Pathologic - pathology; Predictive Value of Tests; Prognosis; Severity of Illness Index; Stroke; Stroke - diagnostic imaging; Stroke - etiology; Surgery; Tomography, X-Ray Computed; Ultrasonography
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2010.11.002

Abstract Introduction Indication to carotid revascularisation is commonly determined by percent of stenosis as well as neurological symptoms and clinical conditions. High plaque embolic potential is defined as ‘vulnerability’; however, its characterisation is not universally used for carotid revascularisation. We investigated the role of contrast-enhanced ultrasonography (CEUS) to identify carotid vulnerable plaque. Methods Patients undergoing carotid endarterectomy were preoperatively evaluated by cerebral computed tomography (CT) scan and CEUS. Contrast microbubbles detected within the plaque indicated neovascularisation and were quantified by decibel enhancement (dB-E). Plaques were histologically evaluated for five features: (microvessel density, fibrous cap thickness, extension of calcification, inflammatory infiltrate and lipid core) and blindly scored 1–5 to assess plaque vulnerability. Analysis of variance (ANOVA), Fisher’s and Student’s t -test were used to correlate patients’ characteristics, histological features and dB-E. Results In 22 patients, dB-E (range 2–7.8, mean 4.85 ± 1.9 SD) was significantly greater in symptomatic (7.40 ± 0.5) vs. asymptomatic (3.5 ± 1.4) patients ( p  = 0.002). A higher dB-E was significantly associated with thinner fibrous cap (