Carotid contrast-enhanced ultrasound assessment of plaque vulnerability and its correlation with ischemic stroke

doi:10.3877/cma.j.issn.1672-6448.2023.10.007

Abstract

Abstract:

Objective

To evaluate the correlation between plaque vulnerability assessed by contrast-enhanced ultrasound (CEUS) and ischemic stroke so as to identify "high-risk" vulnerability characteristics that are closely related to the occurrence of ischemic stroke.

Methods

Fifty-one patients who underwent carotid endarterectomy (CEA) at the Stroke Center of the First Affiliated Hospital of Suzhou University from January 2019 to December 2019 were evaluated for plaque vulnerability by CEUS before operation. Based on the direction of the contrast agent that diffused within the plaques, the plaques were divided into "inside-outside" direction (contrast agent diffused from the artery lumen towards the inside of the plaque) and "outside-inside" direction (contrast agent diffused from the adventitia towards the inside of the plaque). Plaque enhancement degree were divided into no enhancement, moderate enhancement, and extensive enhancement. According to the occurrence of ischemic stroke, the patients were divided into a symptomatic group and an asymptomatic group. The correlation between CEUS perfusion pattern and enhancement degree and ischemic stroke symptoms was analyzed according to histopathological gold standard.

Results

Among the 51 plaques, 23 (23/51, 45.1%) had "inside-out" perfusion mode, of which 18 were typical ulcerative and 5 were fissured plaques. The incidence of cap rupture was significantly higher in plaques with the "inside to outside" direction perfusion pattern than in those with the "outside to inside" direction perfusion pattern (neovascularization) (73.9% vs 25.0%, P<0.001). Multivariate analysis showed that the "inside to outside" perfusion pattern was an independent risk factor for plaque fibrous cap rupture (odds ratio=8.5, 95% confidence interval: 2.4-30.1). Among the 51 patients, 42 were symptomatic and 9 were asymptomatic. The incidence of "inside to outside" perfusion pattern plaques was significantly higher in patients with ischemic stroke symptoms than in asymptomatic patients (52.4% vs 11.1%, P=0.024). There was no significant difference in plaque enhancement grades between symptomatic and asymptomatic patients (P=0.649).

Conclusion

Plaque "inside to outside" perfusion pattern can provide an essential morphological marker for diagnosing plaque fibrous cap rupture. It is a "high risk" vulnerability feature closely related to the occurrence of ischemic stroke.

Key words: Vulnerable plaque, Contrast-enhanced ultrasound, Perfusion pattern, Fibrous cap rupture

Qi Lyu, Pinjing Hui, Yafang Ding, Yanhong Yan. Carotid contrast-enhanced ultrasound assessment of plaque vulnerability and its correlation with ischemic stroke[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1040-1045.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2023.10.007

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Figures/Tables 6

References 17

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患者资料	分析结果
年龄（岁，）	67.0±6.5
性别[男，例（%）]	43（84.3）
有症状[例（%）]	42（82.4）
高血压[例（%）]	31（60.8）
糖尿病[例（%）]	28（54.9）
卒中家族史[例（%）]	9（17.6）
心血管病史[例（%）]	15（29.4）
血脂异常[例（%）]	27（52.9）
总胆固醇（mmol/L，）	3.6±0.7
高密度脂蛋白（mmol/L，）	1.0±0.3
低密度脂蛋白（mmol/L，）	2.1±0.6
甘油三酯（mmol/L，）	1.2±0.5
BMI（kg/m²，）	23.9±4.5
吸烟[例（%）]	21（41.2）
C-反应蛋白（mg/L，）	4.5±4.8

患者资料	分析结果
年龄（岁，）	67.0±6.5
性别[男，例（%）]	43（84.3）
有症状[例（%）]	42（82.4）
高血压[例（%）]	31（60.8）
糖尿病[例（%）]	28（54.9）
卒中家族史[例（%）]	9（17.6）
心血管病史[例（%）]	15（29.4）
血脂异常[例（%）]	27（52.9）
总胆固醇（mmol/L，）	3.6±0.7
高密度脂蛋白（mmol/L，）	1.0±0.3
低密度脂蛋白（mmol/L，）	2.1±0.6
甘油三酯（mmol/L，）	1.2±0.5
BMI（kg/m²，）	23.9±4.5
吸烟[例（%）]	21（41.2）
C-反应蛋白（mg/L，）	4.5±4.8

超声造影模式	病理结果		总计
超声造影模式	纤维帽破裂	纤维帽完整	总计
“由内向外”灌注模式	21	2	23
“由外向内”灌注模式	3	25	28
总计	24	27	51

超声造影模式	病理结果		总计
超声造影模式	纤维帽破裂	纤维帽完整	总计
“由内向外”灌注模式	21	2	23
“由外向内”灌注模式	3	25	28
总计	24	27	51

灌注模式	例数	纤维帽破裂	斑块内出血	大脂质核心	血栓
由内向外	23	21（91.3）	17（73.9）	15（65.2）	7（30.4）
由外向内	28	3（10.7）	12（42.9）	13（46.4）	6（21.4）
χ²值		12.126	4.965	1.800	3.417
P值		<0.001	0.026	0.180	0.463

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