title: Contrast-enhanced ultrasound for the evaluation of neovascularization in atherosclerotic carotid artery plaques.
abstract: OBJECTIVE
  Neovascularization associated with plaque vulnerability, particularly in the plaque shoulder, is susceptible to rupture, causing ischemic events. We aimed to use contrast-enhanced ultrasound to evaluate neovessels in carotid plaques quantitatively, focusing on plaque shoulders.
  
  
  METHODS
  Using contrast-enhanced ultrasound with perflubutane, we analyzed 50 consecutive patients who underwent carotid endarterectomy. We measured enhanced intensity and assessed the correlation between contrast effect and histopathology, comparing symptomatic and asymptomatic plaques.
  
  
  RESULTS
  Enhanced intensity of the plaque shoulder was associated with neovessel density (P<0.01; ρ=0.43). Enhanced intensity of the plaque shoulder was higher in plaques with rupture than in those without (P<0.05), and in symptomatic plaques (n=31) than in asymptomatic ones (n=19; P<0.01).
  
  
  CONCLUSIONS
  Quantitative evaluation of the contrast effect using contrast-enhanced ultrasound enabled the assessment of neovascularization of plaque shoulders in vivo real time, which may help stratify plaque vulnerability.
authors.affiliation: From the Departments of Neurology (K.S., K.N., A.W., H.K.), Pathology (H.I.-U.), Neurosurgery (K.I.), National Cerebral and Cardiovascular Center, Osaka, Japan. ksaito@ncvc.go.jp.
authors.forename: Kozue
authors.initials: K
authors.lastname: Saito
authors.affiliation: From the Departments of Neurology (K.S., K.N., A.W., H.K.), Pathology (H.I.-U.), Neurosurgery (K.I.), National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagatsuka
authors.affiliation: From the Departments of Neurology (K.S., K.N., A.W., H.K.), Pathology (H.I.-U.), Neurosurgery (K.I.), National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Hatsue
authors.initials: H
authors.lastname: Ishibashi-Ueda
authors.affiliation: From the Departments of Neurology (K.S., K.N., A.W., H.K.), Pathology (H.I.-U.), Neurosurgery (K.I.), National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Watanabe
authors.affiliation: From the Departments of Neurology (K.S., K.N., A.W., H.K.), Pathology (H.I.-U.), Neurosurgery (K.I.), National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kannki
authors.affiliation: From the Departments of Neurology (K.S., K.N., A.W., H.K.), Pathology (H.I.-U.), Neurosurgery (K.I.), National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Iihara
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D016894:Endarterectomy, Carotid; D006801:Humans; D008297:Male; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging* / Q000473:pathology; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography
keywords: carotid stenosis; contrast agents; neovascularization; ultrasonography