Do Carotid Plaque Ulcers Heal? Potential Detection of Carotid Artery Plaque Healing by Carotid Ultrasound Imaging

2020 ◽  
Author(s):  
Marialaura Simonetto ◽  
Sushrut Dharmadhikari ◽  
Ari Bennett ◽  
Nelly Campo ◽  
Negar Asdaghi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Ultrasound Imaging ◽  
Carotid Plaque ◽  
Carotid Ultrasound ◽  
Carotid Artery Plaque

Abstract P322: Association of Hiv Infection With Carotid Artery Plaque Echomorphology in the Women’s Interagency HIV Study (wihs)

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Claudio A Bravo ◽  
Jee-Young Moon ◽  
Jean Claude Uwamungu ◽  
Robert Kaplan ◽  
Kathryn Anastos ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Carotid Artery ◽  
Hiv Infection ◽  
Carotid Plaque ◽  
Cd4 Count ◽  
Morbidity And Mortality ◽  
Hiv Care ◽  
Carotid Artery Plaque ◽  
Hiv Women ◽  
Hiv Negative

Introduction: Cardiovascular disease is a major contributor to morbidity and mortality among women living with HIV (WLWH). We previously found HIV infection to be associated with carotid artery plaque, a marker of subclinical atherosclerosis. Plaque morphology and composition may predict plaque rupture and cardiovascular disease events. We characterized the association of HIV-related factors with carotid plaque echomorphology in the WIHS. Methods: Using B-mode ultrasound, we characterized plaque (focal intima-media thickness >1.5 mm) at 6 locations in the right carotid artery in 1,722 participants (1,230 HIV+, 492 HIV-) of the WIHS, a cohort study of women with or at risk for HIV at 6 US sites. Plaque echomorphologic features included relative echogenicity (>50% of plaque is echolucent vs >50% of plaque is echogenic) and surface morphology (smooth vs irregular, i.e., height variations along contour of plaque). We used multinomial logistic regression to assess the odds of each feature vs no plaque comparing HIV+ and HIV- women, adjusting for demographic (e.g., age, race/ethnicity, socioeconomic status), behavioral (e.g., drug/alcohol use, smoking, HCV infection, smoking), cardiometabolic (e.g., systolic blood pressure, BMI, lipids, diabetes) and HIV-related risk factors (e.g., antiretroviral therapy use, current CD4+ T-cell count, AIDS). We further stratified WLWH by CD4+ count (<200, 200-499, 500+ cells/uL) and HIV-1 RNA suppression. Results: Among 1,722 women (median age 40, IQR 33-46, 59% black, 29% Hispanic, 71% HIV+), 160 (9%) had at least one carotid plaque (128 HIV+, 32 HIV-). In unadjusted analyses, WLWH had more echolucent plaque (5.3% vs 2.6%, p=0.02) and plaques with smooth surface (2.7% vs 0.6%, p=0.005) than HIV-negative women. After covariate adjustment, HIV serostatus remained significantly associated with smooth plaque (odds ratio [OR] 3.45, 95% CI 1.12-10.62) but not with echolucent plaque (OR 1.60, 95% CI 0.84-3.05). Stratified by HIV viremia, WLWH with unsuppressed HIV viremia had significantly more smooth plaque (OR 3.34, 95% CI 1.26-8.87) than HIV- women, whereas suppressed WLWH did not (OR 1.79, 95% CI 0.55-5.83). In a dose-response manner, lower CD4+ count among WLWH was associated with smooth plaque (e.g., OR for <200 cells/uL compared with HIV-negative women 7.43, 95% CI 1.46-37.87), and this association was of greater magnitude than that with irregular plaque (OR 2.46, 95% CI 1.14-5.32). Low CD4+ count was also associated with both echolucent (OR 3.36 for <200 cells/uL vs HIV-negative, 95% CI 1.29-8.77) and echogenic plaque (OR 2.65, 95% CI 1.18-5.96). Conclusions: Unsuppressed viremia and low CD4+ count, which are markers of suboptimal HIV care, were associated with certain echomorphologic features of carotid plaque. Further work should assess whether these features differentially lead to cardiovascular morbidity and mortality in WLWH.

Abstract 957: Elevated Levels of Neopterin are Associated with Carotid Complex Plaques in Patients with Stable Angina Pectoris

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Kenichi Sugioka ◽  
Takahiko Naruko ◽  
Takeshi Hozumi ◽  
Shoichi Ehara ◽  
Takuhiro Okuyama ◽  
...  
Keyword(s):  
Angina Pectoris ◽  
Carotid Artery ◽  
Stable Angina ◽  
Carotid Plaque ◽  
Coronary Vessels ◽  
Surface Irregularity ◽  
Stable Angina Pectoris ◽  
Carotid Artery Plaque ◽  
Plaque Score ◽  
Carotid Plaques

Background: Neopterin is produced by activated macrophages and serves as an activation marker for monocytes/macrophages. Serum levels of neopterin have been shown to be associated with the presence of complex coronary lesions in unstable angina pectoris. However, the relationship between neopterin levels and complex carotid lesions is still unknown. We investigated the association between plasma neopterin levels and the characteristics of carotid plaques in patients with stable angina pectoris (SAP). Moreover, we immunohistochemically studied the presence of neopterin in carotid endarterectomy specimens. Methods: We studied 65 SAP patients who were scheduled coronary angiography. In all patients, plasma neopterin levels were measured and carotid ultrasound was performed for evaluation of carotid artery plaque score (PS) defined by the sum of plaque thickness, plaque number (PN) and plaque surface irregularity. Frozen tissue of 40 endarterectomy specimens for extracranial high-grade carotid stenosis were immunohistochemically examed with antibodies against macrophages and neopterin. Results: There was no significant correlation between plasma neopterin levels and PS (P=0.38) or PN (P=0.49). On the other hand, plasma neopterin levels were significantly higher in patients with carotid plaque surface irregularity compared with patients without it (25.4 ± 13.5 nmol/L vs.16.9 ± 6.5 nmol/L, P=0.0015). Carotid plaque irregularity was detected more frequently in patients with higher neopterin levels (>=18.5 nmol/L median) compared with those with lower neopterin levels (41.9% vs. 16.1%, P=0.025). Using multivariate analyses, nepopterin levels (OR, 1.11; 95%CI, 1.01 to 1.21; P=0.023) and the number of diseased coronary vessels (OR, 2.51; 95%CI, 1.01 to 6.22; P=0.047) are independently associated with carotid plaque irregularity. Immunohistochemical staining showed abundant neopterin-positive macrophages in the unstable carotid plaques. Conclusions: Neopterin levels are associated with carotid complex plaques rather than the severity of carotid atherosclerotic change. Neopterin can be considered as one of the significant markers of plaque destabilization in not only coronary artery but carotid artery atherosclerotic lesions.

scholarly journals Detection of Symptomatic Carotid Plaque Using Source Data from MR and CT Angiography: A Correlative Study

2015 ◽  
Vol 39 (3-4) ◽  
pp. 151-161 ◽  
Author(s):  
Ajay Gupta ◽  
Hediyeh Baradaran ◽  
Edward E. Mtui ◽  
Hooman Kamel ◽  
Ankur Pandya ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Ct Angiography ◽  
Carotid Plaque ◽  
Source Imaging ◽  
Carotid Artery Plaque ◽  
Symptomatic Disease ◽  
Symptomatic Carotid ◽  
Calcified Plaque ◽  
Soft Plaque

Background: Carotid plaque MRI has been a useful method to characterize vulnerable atherosclerotic plaque elements. Recent investigations have suggested that source images from CT angiography (CTA) and MR angiography (MRA) can identify the simple high-risk features of symptom-producing carotid artery plaque. We studied the correlation and relative diagnostic accuracies of CTA and MRA source images in detecting symptomatic carotid artery plaque. Methods: Subjects were eligible if they had carotid stenosis between 50 and 99% and had MRA and CTA exams performed within 10 days of one another. We measured the soft (non-calcified) plaque and hard (calcified) plaque thickness on CTA axial source images and intraplaque high-intensity signal (IHIS) on 3D-time-of-flight MRA source images in subjects. We assessed whether a correlation existed between increasing CTA soft plaque thicknesses and the presence of MRA IHIS using the Student's t-test. We calculated the differences in sensitivity and specificity measures of CTA and MRA source-imaging data with the occurrence of recent ipsilateral stroke or transient ischemic attack (TIA) as the reference standard. We also performed logistic regression analyses to evaluate the predictive strength of plaque showing both IHIS and increased CTA soft plaque thickness in predicting symptomatic disease status. Results: Of 1994 screened patients, 48 arteries met the final inclusion criteria with MRA and CTA performed within 10 days of one another. The mean and median time between CTA and MRA exams were 2.0 days and 1 day, respectively. A total of 34 of 48 stenotic vessels (70.8%) were responsible for giving rise to ipsilateral stroke or TIA. CTA mean soft plaque thickness was significantly greater (4.47 vs. 2.30 mm, p < 0.0001) in patients with MRA-defined IHIS, while CTA hard plaque thickness was significantly greater (2.09 vs. 1.16 mm, p = 0.0134) in patients without MRA evidence of IHIS. CTA soft plaque thickness measurements were more sensitive than MRA IHIS (91.2 vs. 67.6%, p = 0.011) in detecting symptomatic plaque, while differences in specificity were not significantly different (p = 0.1573). In the subset of patients with both IHIS on MRA and plaque thickness >2.4 mm on CTA, the odds ratio of detecting symptomatic plaque, corrected for stenosis severity, was 45.3 (p < 0.0005). Conclusions: Unprocessed source images from CTA and MRA, which are routinely evaluated for clinical studies demonstrate the highly correlated presence of IHIS and increasing soft plaque thickness. In particular, plaque that shows high-risk features on both MRA and CTA are very strongly associated with symptom-producing carotid plaque. With further validation, such techniques are promising practical methods of extracting risk information from routine neck angiographic imaging.

Virtual Histology Intravascular Ultrasound Assessment of Carotid Artery Disease: The Carotid Artery Plaque Virtual Histology Evaluation (CAPITAL) Study

2007 ◽  
Vol 14 (5) ◽  
pp. 676-686 ◽  
Author(s):  
Edward B. Diethrich ◽  
M. Pauliina Margolis ◽  
Donald B. Reid ◽  
Allen Burke ◽  
Venkatesh Ramaiah ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Diagnostic Accuracy ◽  
Intravascular Ultrasound ◽  
Carotid Plaque ◽  
Carotid Artery Disease ◽  
Cerebral Protection ◽  
Histological Evaluation ◽  
Carotid Artery Plaque ◽  
Virtual Histology ◽  
Virtual Histology Intravascular Ultrasound

Purpose: To determine the diagnostic accuracy of virtual histology intravascular ultrasound imaging (VH IVUS) of carotid plaque and to assess the feasibility of VH IVUS to identify plaque with embolic potential in patients undergoing carotid artery stenting (CAS). Methods: Thirty patients (17 men; mean age 74±7 years) were entered nonrandomly into a single-center, prospective, 2-arm study following FDA and Institutional Review Board approval. In one arm, 15 patients underwent VH IVUS examination of carotid plaque with a cerebral protection device immediately followed by carotid endarterectomy (CEA). A comparison of “virtual” with true histology was then performed, classifying plaque type by VH IVUS and histopathology in a blinded study. In the second arm, 15 patients undergoing CAS had a preliminary VH IVUS scan performed with cerebral protection. Debris collected from the filter following stenting was examined histologically and compared with the VH IVUS data. Results: The diagnostic accuracy of VH IVUS to agree with true histology in different carotid plaque types was 99.4% in thin-cap fibroatheroma, 96.1% for calcified thin-cap fibroatheroma, 85.9% in fibroatheroma, 85.5% for fibrocalcific, 83.4% in pathological intimal thickening, and 72.4% for calcified fibroatheroma. Filter debris was captured in 2 patients prior to CEA and in 4 patients undergoing CAS for restenosis; VH IVUS classification of plaque composition was consistent with the histological evaluation of filter fragments. Calcified nodules projecting into the carotid artery lumen were associated with a higher incidence of previous neurological symptoms (66.7% versus 33.3%, p<0.05), while patients on aspirin has significantly less necrotic lipid core plaque detected by VH IVUS than patients not taking aspirin (6.4%±4.7% versus 9.7%±2.8%, p<0.05). Conclusion: This study showed a strong correlation between VH IVUS plaque characterization and the true histological examination of the plaque following endarterectomy, particularly in “vulnerable” plaque types. The feasibility study to examine VH IVUS data and the filter debris histology in CAS patients supports a larger prospective study.

CAROTID PLAQUE CHARACTERISTICS AND ITS PREVALENCE IN PATIENTS WITH CORONARY ARTERY DISEASE: AN OBSERVATIONAL STUDY

2021 ◽  
Vol 5 (10) ◽  
Author(s):  
Kirtiman Singh ◽  
Abhishek Rathore ◽  
Indu Bhana ◽  
Mahendra Chourasiya
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Carotid Artery ◽  
Common Carotid Artery ◽  
Carotid Plaque ◽  
Cardiovascular Events ◽  
Carotid Ultrasonography ◽  
Carotid Artery Plaque ◽  
The Common ◽  
Artery Disease

Background and Aims: To evaluate the prevalence and clinical significance of carotid artery plaque, in patients with coronary artery disease. Material and Methods: A total of 1000 patients with 40-80 years of age with coronary artery disease were enrolled. Carotid ultrasonography was performed in all these patients. Results: Among 100 patients with carotid artery disease, 36 had a carotid plaque. In plaque-positive cases, a majority of patients were in a 50 – 60-year age group. Dyslipidemia was found to be the most common risk factor for carotid plaque. In 36 plaque-positive cases, 20 (56%) were having the plaque at the carotid bulb and 16 (44%) were having the plaque at the common carotid artery. Out of 36 cases, 16 (44%) were hyperechogenic, 8 (22%) were calcified, 6 (17%) were moderate echogenic, 6 (17%) were low echogenic. Conclusion: High-resolution B-mode ultrasonography is a useful non-invasive method to evaluate carotid atherosclerosis. Carotid plaques of the common carotid artery are a surrogate marker of atherosclerosis and associated with cardiovascular events. Routine screening of patients with coronary artery disease may be considered. Keywords: Carotid artery stenosis, coronary artery disease, cardiovascular events, atherosclerosis, carotid ultrasonography.

Carotid Artery Plaque Calcifications: Lessons From Histopathology to Diagnostic Imaging

Stroke ◽  
2021 ◽  
Author(s):  
Luca Saba ◽  
Valentina Nardi ◽  
Riccardo Cau ◽  
Ajay Gupta ◽  
Hooman Kamel ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Plaque ◽  
Intraplaque Hemorrhage ◽  
Calcium Deposition ◽  
Carotid Artery Plaque ◽  
Carotid Plaques ◽  
Novel Technologies ◽  
Carotid Artery Calcification ◽  
Wide Range

The role of calcium in atherosclerosis is controversial and the relationship between vascular calcification and plaque vulnerability is not fully understood. Although calcifications are present in ≈50% to 60% of carotid plaques, their association with cerebrovascular ischemic events remains unclear. In this review, we summarize current understanding of carotid plaque calcification. We outline the role of calcium in atherosclerotic carotid disease by analyzing laboratory studies and histopathologic studies, as well as imaging findings to understand clinical implications of carotid artery calcifications. Differences in mechanism of calcium deposition express themselves into a wide range of calcification phenotypes in carotid plaques. Some patterns, such as rim calcification, are suggestive of plaques with inflammatory activity with leakage of the vasa vasourm and intraplaque hemorrhage. Other patterns such as dense, nodular calcifications may confer greater mechanical stability to the plaque and reduce the risk of embolization for a given degree of plaque size and luminal stenosis. Various distributions and patterns of carotid plaque calcification, often influenced by the underlying systemic pathological condition, have a different role in affecting plaque stability. Modern imaging techniques afford multiple approaches to assess geometry, pattern of distribution, size, and composition of carotid artery calcifications. Future investigations with these novel technologies will further improve our understanding of carotid artery calcification and will play an important role in understanding and minimizing stroke risk in patients with carotid plaques.

scholarly journals Carotid plaque neovascularization by contrast-enhanced carotid ultrasound imaging coincides with plaque inflammation by microwave radiometry

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P4180-P4180 ◽  
Author(s):  
M. Drakopoulou ◽  
K. Toutouzas ◽  
C. Aggeli ◽  
G. Benetos ◽  
C. H. Nikolaou ◽  
...  
Keyword(s):  
Ultrasound Imaging ◽  
Carotid Plaque ◽  
Microwave Radiometry ◽  
Carotid Ultrasound ◽  
Contrast Enhanced ◽  
Plaque Inflammation

scholarly journals Carotid Ultrasound Screening Programs in Rural Communities: A Systematic Review

2021 ◽  
Vol 11 (9) ◽  
pp. 897
Author(s):  
Marjana Petrova ◽  
Hosen Kiat ◽  
Alex Gavino ◽  
Craig S. McLachlan
Keyword(s):  
Systematic Review ◽  
Rural Communities ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Plaque ◽  
Carotid Atherosclerosis ◽  
Random Effect ◽  
Ultrasound Screening ◽  
Carotid Ultrasound ◽  
Screening Programs

Carotid atherosclerosis assessments inform about stroke and cardiovascular risk. It is known that stroke and cardiovascular disease (CVD) prevalence is higher in rural communities than in urban communities. We aimed to conduct a systematic review of rural carotid ultrasound screening programs to define carotid atherosclerosis using traditional and emerging imaging biomarkers, prevalence, and risk factors. We searched Ovid/MEDLINE, Ovid/EMBASE, SCOPUS and CINAHL from inception to 3 April 2020 for rural population studies that utilized carotid ultrasound screening for adults ≥40 years of age and free of known cerebrovascular disease. Studies were included if participants received a bilateral ultrasound scanning of the carotid arteries and reported at least one marker of carotid atherosclerosis pathology. A random effect meta-analyses calculated the estimated prevalence of carotid plaque. In total, 22/3461 articles that met all of the inclusion criteria were included. Studies reported increased intima media thickness (IMT), carotid plaque presence and carotid artery stenosis. There were no studies reporting on novel imaging markers, such as carotid stiffness, carotid plaque morphology or neovascularization. The overall random effect pooled prevalence of carotid plaque was 34.1% (95% CI, 33.6–35.0); the prevalence of increased IMT was 11.2–41.5%, and the prevalence of carotid artery stenosis was 0.4–16.0%. There is an absence of data necessary to understand the carotid atherosclerosis prevalence across global rural populations. Represented studies have focused on East Asian countries where a high burden of rural carotid artery disease has been reported. There is no rural evidence to guide the use of novel ultrasound carotid biomarkers such as stiffness or neovascularization.

P4389Effect of cigarette smoking on carotid artery atherosclerosis: a community-based cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Kiriyama ◽  
H Kaneko ◽  
H Itoh ◽  
Y Yoshida ◽  
K Nakanishi ◽  
...  
Keyword(s):  
Cardiovascular Diseases ◽  
High Risk ◽  
Carotid Artery ◽  
Cigarette Smoking ◽  
Carotid Plaque ◽  
Subclinical Atherosclerosis ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Carotid Artery Plaque ◽  
Never Smokers

Abstract Background Cigarette smoking is closely associated with the development of cardiovascular diseases (CVD), and the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines recommend smoking bans.On the other hand, the relationship between cigarette smoking and subclinical atherosclerosis has not been fully studied. Carotid intima-media thickness (cIMT) is commonly used as a subclinical atherosclerosis marker, and a carotid plaque feature is also known to be an important predictor of cardiovascular diseases. Purpose We sought to clarify the association between cigarette smoking and subclinical atherosclerosis by evaluating carotid plaque including cIMT and carotid plaque features in general population. Methods and results Among 1,209 participants with no prior coronary artery disease who received a medical check-up with cardiovascular examination at our institution, 450 participants (37.2%) were smokers (including both past and current smokers). We defined carotid plaque as cIMT ≥1.1 mm and high-risk plaque as carotid plaque with hypoechoic dominant and/or plaque ulceration. The value of cIMT and the rate of carotid plaque were not different between smokers and never smokers (Figure A & B). However, the rate of carotid high-risk plaque was significantly higher in participants with smokers than those with never smokers (29.7%, vs 23.5%, p=0.011) (Figure C). Even after adjustment with covariates including age, gender and traditional cardiovascular risk factors, cigarette smoking was independently associated with high-risk plaque formation (odds ratio 1.384, 95% CI 1.020–1.877; p=0.037). According to the subgroup analysis classified by age, cigarette smoking was associated with not only the development of high-risk plaque but also the increased value of cIMT in the subgroup over 60 years old, whereas only the rate of high-risk plaque was higher in smokers than never smokers in the subgroup under 60 years old. Carotid plaque and smoking Conclusion The development of high-risk carotid artery plaque may precede thickening of cIMT in cigarette smokers, suggesting that the novel insight for the pathological mechanism underlying cardiovascular events and cigarette smoking.

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