title: The use of contrast enhanced ultrasound in carotid arterial disease.
abstract: Traditionally, stroke risk stratification has centred on the degree of internal carotid artery stenosis, and the presence of focal neurological symptoms. However, degree of stenosis alone is a relatively poor predictor of future stroke in asymptomatic patients; the Asymptomatic Carotid Surgery Trial highlighting the need to identify a subgroup of asymptomatics that may benefit from intervention. Attempting to define this subgroup has inspired imaging research to identify, in vivo, high-risk plaques. In addition to pre-operative risk stratification of carotid stenosis, contrast enhanced ultrasound (CEUS) may be employed in monitoring response to plaque-stabilising therapies. Unlike most contrast agents used for computed tomography and magnetic resonance imaging, microbubbles used in CEUS remain within the vascular space and can hence be used to study the vasculature. In addition to improving current carotid structural scans, CEUS has potential to add extra information on plaque characteristics. Furthermore, by targeting microbubbles to specific ligands expressed on vascular endothelium, CEUS may have the ability to probe plaque biology. This review describes the current carotid ultrasound examination and the need to improve it, rationale for imaging neovascularisation, use of CEUS to image neovascularisation, microbubbles in improving the structural imaging of plaque, potential problems with CEUS, and future directions.
authors.affiliation: Imperial Vascular Unit, Department of Vascular Surgery, Imperial College London, 4th Floor, Charing Cross Hospital, Fulham Palace Road, London, UK. j.shalhoub@imperial.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Shalhoub
authors.forename: D R J
authors.initials: DR
authors.lastname: Owen
authors.forename: T
authors.initials: T
authors.lastname: Gauthier
authors.forename: C
authors.initials: C
authors.lastname: Monaco
authors.forename: E L S
authors.initials: EL
authors.lastname: Leen
authors.forename: A H
authors.initials: AH
authors.lastname: Davies
mesh_terms: D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D003287:Contrast Media; D006801:Humans; D045423:Microbubbles; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012421:Rupture; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media