Visual and digital analysis of the ultrasound image in a stable and progressive carotid atherosclerotic plaque

Czech version

Authors: D. Školoudík- ^{1 3}; P. Kešnerová ⁴; T. Hrbáč ³; D. Netuka ⁵; J. Vomáčka ⁶; K. Langová ⁷ ; M. Roubec ¹; R. Herzig ⁸; T. Belšan ⁹; Pro Antique Trial Group
Authors‘ workplace: Centrum zdravotnického výzkumu, LF OU, Ostrava ¹; Neurologické oddělení, Iktové centrum, Vítkovická nemocnice, Ostrava ²; Neurochirurgická klinika, Komplexní cerebrovaskulární centrum, FN Ostrava ³; Neurologická klinika, Komplexní cerebrovaskulární centrum, 2. LF UK a FN Motol, Praha ⁴; Neurochirurgická klinika, Komplexní cerebrovaskulární centrum, ÚVN – VFN Praha ⁵; Ústav radiologické asistence, UP v Olomouci ⁶; Ústav biofyziky, LF a Institut molekulární a translační medicíny, UP v Olomouci ⁷; Neurologická klinika, Komplexní cerebrovaskulární centrum, LF UK a FN Hradec Králové ⁸; Radiologická klinika, Komplexní cerebrovaskulární centrum, ÚVN – VFN Praha ⁹
Published in: Cesk Slov Neurol N 2021; 84/117(1): 38-44
Category: Original Paper
doi: https://doi.org/10.48095/cccsnn202138

Overview

Aim: Early identification of patients at higher risk of unstable atherosclerotic plaque development is essential for successful preventive treatment. The aim of the study was to identify the duplex sonography carotid atherosclerotic plaque risk characteristics for plaque progression.

Methods: All patients who underwent regular sonographic examinations within 36 months were included in the analysis. At each control, the following characteristics of the atherosclerotic plaque in the carotid artery were evaluated: maximum width, echogenicity, homogeneity, plaque surface and the presence of calcifications. Univariate and multivariate logistic regression analyses were used for the statistical evaluation.

Results: Stable atherosclerotic plaques in both carotid arteries were detected in 332 patients (125 males, mean age 66.7 ± 9.7 years). Progressive atherosclerotic plaque in at least one carotid artery was detected in 255 patients (126 males, mean age 69.5 ± 8.3 years). Multivariate logistic regression analysis identified 3 risk factors for carotid atherosclerotic plaque progression: plaque width (increasing the risk of plaque progression within 3 years by 73.5% per 1 mm; P < 0.0001), irregular plaque surface (increasing the risk of progression by 56.4%; P = 0.007) and exulcerated plaque (increasing the risk of progression by 81.9%; P = 0.025).

Conclusion: The width and irregular and exulcerated surface of the carotid atherosclerotic plaque are independent risk factors for plaque progression.

Keywords:

Atherosclerosis – plaque – ultrasound – progression – risk factor

Sources

1. Flaherty ML, Kissela B, Khoury JC et al. Carotid artery stenosis as a cause of stroke. Neuroepidemiology 2013; 40 (1): 36–41. doi: 10.1159/000341410.

2. Fishbein MC. The vulnerable and unstable atherosclerotic plaque. Cardiovasc Pathol 2010; 19 (1): 6–11. doi: 10.1016/j.carpath.2008.08.004.

3. Ooi YC, Gonzalez NR. Management of extracranial carotid artery disease, Cardiol Clin 2015; 33 (1): 1–35. doi: 10.1016/j.ccl.2014.09.001.

4. Školoudík D, Škoda O, Bar M et al. Neurosonologie. Praha: Galén 2003.

5. Spence D. Treating arteries instead of risk factors. A paradigm change in management of atherosclerosis. Stroke 2010; 41 (6): 1193–1199. doi: 10.1161/STROKEAHA. 110.577973.

6. Kešnerová P, Vizlayová D, Školoudík D. Detekce nestabilního karotického plátu v prevenci ischemické cévní mozkové příhody. Cesk Slov Neurol N 2018; 81/114 (4): 378–391. doi: 10.14735/amcsnn2018378.

7. Andrews JP, Fayad ZA, Dweck MR. New methods to image unstable atherosclerotic plaques. Atherosclerosis 2018; 272: 118–128. doi: 10.1016/j.atherosclerosis.2018.03.021.

8. Naghavi M, Libby P, Falk E et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies, part I. Circulation 2003; 108 (14): 1664–1672. 10.1161/01.CIR.0000087480. 94275.

9. Naghavi M, Libby P, Falk E et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies, part II. Circulation 2003; 108 (15): 1772–1788. doi: 10.1161/01.CIR.0000087481.558 87.C9.

10. Skagen K, Skjelland M, Zamani M et al. Unstable carotid artery plaque: new insights and controversies in diagnostics and treatment. Croat Med J 2016; 57 (4): 311–320. doi: 10.3325/cmj.2016.57.311.

11. Wiśniewska N, Kania E, Płoński A et al. Pathogenesis regarding development and structure of unstable atherosclerotic plaque in internal carotid artery in relation to high risk factors of an ischaemic stroke. Current status of knowledge. Acta Angiol 2019; 25 (3): 145–156. doi: 10.5603/AA.2019.0013.

12. Doonan RJ, Gorgui J, Veinot JP et al. Plaque echodensity and textural features are associated with histologic carotid plaque instability. J Vasc Surg 2016; 64 (3): 671–677. doi: 10.1016/j.jvs.2016.03.423.

13. Zhu G, Hom J, Li Y et al. Carotid plaque imaging and the risk of atherosclerotic cardiovascular disease. Cardiovasc Diagn Ther 2010; 10 (4): 1048–1067. doi: 10.21037/cdt.2020.03.10.

14. Roubec M, Školoudík D, Hrbáč T et al. Krvácení do aterosklerotického plátu u symptomatické a asymptomatické progredující stenózy vnitřní karotidy – pilotní studie. Cesk Slov Neurol N 2019; 82/115 (6): 638–643. doi: 10.14735/amcsnn2019638.

15. Charvát F, Vrána J, Netuka D et al. Charakteristika aterosklerotického plátu a riziko mozkové ischemie při stentování vnitřní karotidy. Cesk Slov Neurol N 2020; 83/116 (1): 84–94. doi: 10.14735/amcsnn202 084.

16. Herzig R, Urbánek K, Vlachová I et al. The role of chronic alcohol intake in patients with spontaneous intracranial hemorrhage: a carbohydrate-deficient transferrin study. Cerebrovasc Dis 2003; 15 (1–2): 22–28. doi: 10.1159/000067118.

17. Meschia JF, Bushnell C, Boden-Albala B et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45 (12): 3754–3832. doi: 10.1161/STR.000000000000 0046.

18. Škoda O, Herzig R, Mikulík R et al. Klinický standard pro diagnostiku a léčbu pacientů s ischemickou cévní mozkovou příhodou a s tranzitorní ischemickou atakou – verze 2016. Cesk Slov Neurol N 2016; 79/112 (3): 351–363. doi: 10.14735/amcsnn2016351.

19. Yanez ND, Burke GL, Manolio T et al. Sibling history of myocardial infarction or stroke and risk of cardiovascular disease in the elderly: the Cardiovascular Health Study. Ann Epidemiol 2009; 19 (12): 858–866. doi: 10.1016/j.annepidem.2009.07.095.

20. Salonen R, Seppänen K, Rauramaa R et al. Prevalence of carotid atherosclerosis and serum cholesterol levels in eastern Finland. Arteriosclerosis 1988; 8 (6): 788–792. doi: 10.1161/01.ATV.8.6.788.

21. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991; 325 (7): 445–453. doi: 10.1056/NEJM199108153250701.

22. Rothwell PM, Gutnikov SA, Warlaw CP. Reanalysis of the final results of the European Carotid Surgery Trial. Stroke 2003; 34 (2): 514–523. doi: 10.1161/01.str.0000 054671.71777.c7.

23. Spence JD, Eliasziw M, DiCicco M et al. Carotid plaque area: a tool for targeting and evaluating vascular preventive therapy. Stroke 2002; 33 (12): 2916–2922. doi: 10.1161/01.STR.0000042207.16156.B9.

24. Xu D, Hippe DS, Underhill HR et al. Prediction of high-risk plaque development and plaque progression with the carotid atherosclerosis score. JACC Cardiovasc Imaging 2014; 7 (4): 366–373. doi: 10.1016/j.jcmg.2013.09.022.

25. Yin R, Ma A, Pan X et al. Biomarkers of cerebral microembolic signals. Clin Chim Acta 2017; 475: 164–168. doi: 10.1016/j.cca.2017.10.028.

26. Esposito-Bauer L, Saam T, Ghodrati I et al. MRI plaque imaging detects carotid plaques with a high risk for future cerebrovascular events in asymptomatic patients. PLoS One 2013; 8 (7): e67927. doi: 10.1371/ journal.pone.0067.

27. Saam T, Cai J, Ma L et al. Comparison of symptomatic and asymptomatic atherosclerotic carotid plaque features with in vivo MR imaging. Radiology 2006; 240 (2): 464–472. doi: 10.1148/radiol.2402050390.

28. Hansson GK, Libby P, Tabas I. Inflammation and plaque vulnerability. J Intern Med 2015; 278 (5): 483–493. doi: 10.1111/joim.12406.

29. Brott TG, Halperin JL, Abbara S et al. 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: executive summary. Vasc Med 2011; 16 (1): 35–77. doi: 10.1177/1358863X11399328.

30. Guňka I, Krajíčková D, Leško M et al. Bezpečnost karotické endarterektomie s ohledem na její načasování po ischemické cévní mozkové příhodě. Cesk Slov Neurol N 2020; 83/116 (4): 394–399. doi: 10.14735/amcsnn2020394.