title: Assessment of the vulnerable carotid atherosclerotic plaque using contrast-enhanced ultrasonography.
abstract: Carotid atherosclerosis represents a primary cause for cerebrovascular ischemic events and its contemporary management includes surgical revascularization for moderate to severe symptomatic stenoses. However, the role of invasive therapy seems to be questioned lately for asymptomatic cases. Numerous reports have suggested that the presence of neovessels within the atherosclerotic plaque remains a significant vulnerability factor and over the last decade imaging modalities have been used to identify intraplaque neovascularization in an attempt to risk-stratify patients and offer management guidance. Contrast-enhanced ultrasonography of the carotid artery is a relatively novel diagnostic tool that exploits resonated ultrasound waves from circulating microbubbles. This property permits vascular visualization by producing superior angiography-like images, and allows the identification of vasa vasorum and intraplaque microvessels. Moreover, plaque neovascularization has been associated with plaque vulnerability and ischemic symptoms lately as well. At the same time, attempts have been made to quantify contrast-enhanced ultrasonography signal using sophisticated software packages and algorithms, and to correlate it with intraplaque microvascular density. The aim of this review was to collect all recent data on the characteristics, performance, and prognostic role of contrast-enhanced ultrasonography regarding carotid stenosis management, and to produce useful conclusions for clinical practice.
authors: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors: Konstantinos
authors: K
authors: Filis
authors: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors: Levon
authors: L
authors: Toufektzian
authors: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors: George
authors: G
authors: Galyfos
authors: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors: Fragiska
authors: F
authors: Sigala
authors: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors: Panagiota
authors: P
authors: Kourkoveli
authors: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors: Sotirios
authors: S
authors: Georgopoulos
authors: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors: Manolis
authors: M
authors: Vavuranakis
authors: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors: Dimitrios
authors: D
authors: Vrachatis
authors: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors: George
authors: G
authors: Zografos
mesh_terms: D000465:Algorithms; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000008:administration & dosage*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D045423:Microbubbles; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D012422:Rupture, Spontaneous; D012984:Software; D014463:Ultrasonography / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: Contrast-enhanced ultrasonography; carotid atherosclerosis; neovascularization; plaque vulnerability