Ultrasound Screening of Multifocal Atherosclerosis

Biomedicines, 2021

Atherosclerosis is a key pathological process that causes a plethora of pathologies, including coronary artery disease, peripheral artery disease, and ischemic stroke. The silent progression of the atherosclerotic disease prompts for new surveillance tools that can visualize, characterize, and provide a risk evaluation of the atherosclerotic plaque. Conventional ultrasound methods—bright (B)-mode US plus Doppler mode—provide a rapid, cost-efficient way to visualize an established plaque and give a rapid risk stratification of the patient through the Gray–Weale standardization—echolucent plaques with ≥50% stenosis have a significantly greater risk of ipsilateral stroke. Although rather disputed, the measurement of carotid intima-media thickness (C-IMT) may prove useful in identifying subclinical atherosclerosis. In addition, contrast-enhanced ultrasonography (CEUS) allows for a better image resolution and the visualization and quantification of plaque neovascularization, which has be...

Journal of Cardiovascular Medicine, 2009

Objective To investigate the usefulness of carotid ultrasound evaluation in predicting the presence and the extent of coronary artery disease in a consecutive series of patients. Design We examined retrospectively 1337 patients in whom both coronary angiography and carotid ultrasound were evaluated, from 1995 to 2005. Markers of carotid artery disease were considered, such as intima-media thickness more than 0.90 mm, unstable plaque and severe stenosis (>-70%). Carotid risk score was defined as the sum of these parameters. We considered as affected by significant coronary artery disease those patients with at least one lesion more than 50% within the main branches of the coronary arteries. Results The markers of carotid atherosclerosis increased proportionally in patients with one-, two-or three-vessel coronary artery disease. At univariate analysis, intimamedia thickness more than 0.90 mm was associated with an odds ratio of coronary artery disease of 2.28 (1.8-2.9) (P < 0.0001), unstable plaque 3.6 (2.3-5.7) (P < 0.001) and severe carotid stenosis 4.2 (2.0-8.7) (P U 0.0001). At multivariate analysis, the three markers mentioned above were independent risk factors for coronary artery disease even when considering other risk factors. Conclusion We confirmed the usefulness of carotid ultrasound evaluation in predicting the presence and extent of coronary artery disease. Considering the high correlation between carotid and coronary artery disease, carotid screening is useful in patients with coronary artery disease. In patients with an occasional finding of a carotid risk score of at least 2, a careful search for coronary artery disease seems warranted. J Cardiovasc Med 10:906-912 Q 2009 Italian Federation of Cardiology.

Aims Although well supported by postmortem studies, the reliability of carotid atherosclerosis as surrogate marker of coronary atherosclerosis has been put in doubt by in vivo studies showing a poor correlation between carotid intima-media thickness (IMT) detected by external carotid ultrasound (ECU) and coronary stenosis assessed by quantitative coronary angiography (QCA). In the present study, we have investigated whether a stronger in vivo correlation between the two arteries can be obtained by using homogeneous variables such as carotid and coronary IMT, detected by ECU and intravascular ultrasound (IVUS), respectively. Methods and results ECU, QCA, and IVUS measurements were made in 48 patients. Carotid IMT was correlated with both angiographic and IVUS findings. A significant but weak correlation was observed between ECU and QCA variables (r % 0.35, P , 0.05); the correlation between ECU and IVUS measurements of IMT was higher, with correlation coefficients ranging from 0.49 to 0.55. In patients with a QCA diagnosis of normal/intermediate coronary atherosclerosis, the presence of a carotid-IMT mean . 1 mm was associated with an 18-fold increase in risk of having a positive IVUS test (OR = 17.99, 95% CI 1.83-177.14, P = 0.013) and with a seven-fold increased risk of having a significant IVUS coronary stenosis (OR = 7.4, 95% CI 1.27-44.0, P = 0.028). Conclusion Carotid atherosclerosis correlates better with coronary atherosclerosis when both circulations are investigated by the same technique (ultrasound) using the same parameter (IMT). This supports the concept that carotid IMT is a good surrogate marker of coronary atherosclerosis.

2010 IEEE International Symposium on Biomedical Imaging: From Nano to Macro, 2010

ABSTRACT Intravascular ultrasound (IVUS) is a technology that uses an ultrasound element on the tip of a catheter. This catheter is advanced through the groin into the coronary arteries. In this way a tomographic image of the vascular wall and atherosclerotic plaques can be produced. Historically is has been used to assess the level of occlusion, the atherosclerotic plaque burden and the native size of the vessel. This information can be used to decide to treat or not and to determine the diameter and length of the stent to be used for treatment. It has also been used extensively to determine if the stent was well deployed. The composition and morphology of an atherosclerotic lesion are currently considered more important determinants of acute coronary ischemic syndromes that the degree of stenosis. When a lesion is unstable, it can rupture and cause an acute thrombotic reaction. An unstable plaque can be characterized by a lipid core that is covered by a thin fibrous cap, which has been locally weakened by inflammatory cells. The last decade serious effort has been put in developing IVUS towards identifying these unstable plaques. This lecture will focus on the development of measuring the elastic properties of the plaque as a marker for plaque instability and measuring the vascularization in the plaque, which plays an important role in the pathogenesis of unstable plaque. Furthermore the role of combined ultrasound/light catheters will be discussed. Technology development and validation will be presented as well as the role of IVUS to provide imaging biomarkers in natural history studies and trials for the development of new cardiovascular drugs.

European Heart Journal, 2010

Atherosclerosis is the main cause of coronary heart disease, which is today the leading cause of death worldwide and will continue to be the first in the world in 2030. In the formation of atherosclerotic coronary lesions, a critical primary step is the accumulation and oxidation of low-density lipoprotein (LDL) particles. Oxidized-LDL favours leucocyte recruitment and their activation, as well as cell death. This leads to generation of complex atherosclerotic plaques. These plaques have a high content of necrotic core, a thin inflamed fibrous cap (intense accumulation of macrophages) and scarce presence of smooth muscle cells (i.e. thin-capped fibroatheroma). At early stages of the formation of the atheroma, the remodelling of the vessel wall usually prevents plaque from encroaching on the lumen, thereby masking the presence of atheroma on angiography. In contrast, greyscale intravascular ultrasound can fully assess the extension of the disease axially and longitudinally. This intravascular imaging technique has played a vital role in advancing our understanding of the pathophysiology of coronary artery disease, and in the development of novel cardiovascular drugs and device therapies. This intravascular imaging technology and its clinical and research applications are discussed in more detail below.

Journal of the Anatomical Society of India, 2014

Introduction: Carotid intima-media thickness (CIMT) testing has emerged as a valuable tool for detecting atherosclerosis. Its relationships with coronary artery disease risk factors, future cardiovascular events, allow it to serve as a suitable diagnosing method for coronary atherosclerosis. The purpose of this study was to investigate the CIMT detected by Ultrasonography as a clinically useful marker for the presence and severity of coronary artery disease (CAD). Materials and Methods: Two hundred consecutive patients (age from 30 ye80 y) who were subjected to coronary angiography also subjected for carotid B-mode ultrasound scan of carotid artery. The mean value of six measurements of IMT of far wall of the common carotid artery and at its bifurcation was calculated in each patient. Result: The mean IMT was significantly correlated to the number of stenosed coronary arteries. The mean CIMT in patients with single vessel disease, double vessel disease and for triple vessel disease was 0.580 ± 0.160 mm, 0.718 ± 0.206 mm and 0.934 ± 0.301 mm respectively, which was higher as compared to control group (0.465 ± 0.144 mm). Discussion: A significant linear correlation between IMT and advancing CAD observed by A Kablak-Ziembicka. Daniel H. O'Leary has reported the prevalence and severity of carotid atherosclerosis continued to increase with age even in the late decades of life. In the present study IMT thickness was increased with age and mean CIMT was found greater for significant CAD as compared to non-significant CAD and for normal coronary arteries thus CIMT may be a clinically valuable parameter in diagnosis of non-significant and significant CAD.

The International Journal of Cardiovascular Imaging, 2013

Ultrasound detection of sub-clinical atherosclerosis (ATS) may help identify individuals at high cardiovascular risk. Most studies evaluated intima-media thickness (IMT) at carotid level. We compared the relationships between main cardiovascular risk factors (CVRF) and five indicators of ATS (IMT, mean and maximal plaque thickness, mean and maximal plaque area) at both carotid and femoral levels. Ultrasound was performed on 496 participants aged 45-64 years randomly selected from the general population of the Republic of Seychelles. 73.4 % participants had C1 plaque (IMT thickening C1.2 mm) at carotid level and 67.5 % at femoral level. Variance (adjusted R2) contributed by age, sex and CVRF (smoking, LDL-cholesterol, HDL-cholesterol, blood pressure, diabetes) in predicting any of the ATS markers was larger at femoral than carotid level. At both carotid and femoral levels, the association between CVRF and ATS was stronger based on plaque-based markers than IMT. Our findings show that the associations between CVRF and ATS markers were stronger at femoral than carotid level, and with plaque-based markers rather than IMT. Pending comparison of these markers using harder cardiovascular endpoints, our findings suggest that markers based on plaque morphology assessed at femoral artery level might be useful cardiovascular risk predictors.

The Indian journal of medical research, 2016

An increase in prevalence of atherosclerosis has been noted worldwide with reports of higher incidence of atherosclerotic vascular changes in Asian Indians. There is a need to measure vascular atherosclerotic changes and provide objective parameter to predict cardiac and cerebrovascular adverse events. Atherosclerotic changes in carotids and coronaries are generally accepted as an association. We attempted in this study to relate intimal-luminal changes in carotid arteries to luminal changes in coronary arteries. Our study presents results of high resolution ultra sonographic (HRUS) evaluation of intimal-medial-thickness (IMT) in carotid with luminal changes in coronaries on multidetector-CT (MDCT) in clinically asymptomatic and symptomatic individuals. In this prospective study, HRUS examination of the carotid bifurcation was performed in 151 individuals to measure IMT in asymptomatic and symptomatic groups. Assessments of coronary arteries of the same group of patients were evalua...

European Journal of Vascular and Endovascular Surgery, 2019

WHAT THIS STUDY ADDS Detection of atherosclerotic plaques by two dimensional (2D) carotid artery ultrasound has demonstrated predictive value for cardiovascular disease in the general population. Three dimensional (3D) ultrasound is a novel technique that may improve plaque detection inasmuch as it allows exploration of almost the entire section of the artery wall. However, in this study, 3D ultrasound showed no higher sensitivity to detect plaques nor did it add any predictive value of coronary artery calcium to 2D ultrasound among a sample of 120 subjects with intermediate cardiovascular risk. Therefore, the use of 2D ultrasound is recommended for cardiovascular risk stratification in subjects with intermediate cardiovascular risk. Background: Current cardiovascular disease (CVD) risk stratification scales, drawn up from traditional risk factors, have important limitations. The detection of subclinical atherosclerosis, by a non-invasive technique such as peripheral arteries ultrasound (US) may improve cardiovascular risk (CVR) stratification, especially in intermediate risk population. Our aim was to compare the predictive power of atherosclerotic plaques detected in carotid and femoral arteries by 2-dimensional (2D) vs. 3-dimensional (3D) US for positive coronary artery calcium score (CACS), used as a proxy for CVD, in a middle-aged sample with intermediate 10-year CVR (7.5e20%). Methods: To detect atherosclerotic plaques by 2D vs. 3D US scan of carotid and femoral arteries and comparison of their association with CACS obtained by computed tomography (CT) of subjects with intermediate CVR belonging to the Aragon Workers' Health Study. Results: 120 men were included, with a 10.4% average 10 years CVR. Forty-one (34.2%) participants had CACS ! 1. 90 participants (75%) had at least one plaque detected by 2D scan while 85 participants (70.8%) had at least a plaque detected by 3D US. Conventional CVR estimates c-statistic for CACS was .590. Although the variables most predicted of CACS ! 1 were those measured by 3D US (total plaque volume and mean of plaque density, cstatistics: .743 and .750 respectively), their predictive capacity was not statistically significantly different from the number of territories with plaque, measured either by 2D and 3D US (c-statistics .728 to .740 respectively). Conclusion: Subclinical atherosclerosis measured by 2D and 3D US were better predictors of CACS ! 1 than CVR estimated by conventional guidelines. In our sample, 3D US did not show any significant advantages with respect to 2D US for the prediction of coronary atherosclerosis.

International Journal of Clinical Neurosciences and Mental Health, 2014

Ischemic heart disease and stroke are the leading causes of death in the world. Myocardial infarction or even death might be the initial presentation of ischemic heart disease. Myocardial infarction is the leading cause of long-term mortality in stroke surviving patients. The aim of this paper is to present the possibilities of predicting coronary artery disease in stroke patients. Evaluating carotid arteries intima-media thickness (IMT), plaque morphology, and degree of stenosis can give us valuable additional information for predicting cardiovascular risk and silent coronary artery disease in otherwise asymptomatic patients. Measuring IMT and assessing carotid atherosclerotic plaque is justified in subjects with high vascular risk profile.