title: Carotid atherosclerotic plaque instability and cognition determined by ultrasound-measured plaque strain in asymptomatic patients with significant stenosis.
abstract: OBJECTIVE This article describes the use of ultrasound measurements of physical strain within carotid atherosclerotic plaques as a measure of instability and the potential for vascular cognitive decline, microemboli, and white matter changes. METHODS Asymptomatic patients with significant (> 60%) carotid artery stenosis were studied for dynamic measures of plaque instability, presence of microemboli, white matter changes, and vascular cognitive decline in comparison with normative controls and premorbid state. RESULTS Although classically asymptomatic, these patients showed vascular cognitive decline. The degree of strain instability measured within the atherosclerotic plaque directly predicted vascular cognitive decline in these patients thought previously to be asymptomatic according to classic criteria. Furthermore, 26% of patients showed microemboli, and patients had twice as much white matter hyperintensity as controls. CONCLUSIONS These data show that physical measures of plaque instability are possible through interpretation of ultrasound strain data during pulsation, which may be more clinically relevant than solely measuring degree of stenosis. The data also highlight the importance of understanding that the definition of symptoms should not be limited to motor, speech, and vision function but underscore the role of vascular cognitive decline in the pathophysiology of carotid atherosclerotic disease. Clinical trial registration no.: NCT02476396 (clinicaltrials.gov).
authors.affiliation: Departments of1Neurological Surgery and.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Dempsey
authors.affiliation: 2Medical Physics, University of Wisconsin School of Medicine and Public Health.
authors.forename: Tomy
authors.initials: T
authors.lastname: Varghese
authors.affiliation: 3Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Daren C
authors.initials: DC
authors.lastname: Jackson
authors.affiliation: 4Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
authors.forename: Xiao
authors.initials: X
authors.lastname: Wang
authors.affiliation: 2Medical Physics, University of Wisconsin School of Medicine and Public Health.
authors.forename: Nirvedh H
authors.initials: NH
authors.lastname: Meshram
authors.affiliation: 5Department of Medicine, Cardiovascular Medicine Division.
authors.forename: Carol C
authors.initials: CC
authors.lastname: Mitchell
authors.affiliation: 6Department of Neurology, University of Wisconsin School of Medicine and Public Health; and.
authors.forename: Bruce P
authors.initials: BP
authors.lastname: Hermann
authors.affiliation: 7Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Waisman Laboratory for Brain Injury and Behavior, University of Wisconsin-Madison & Geriatric Research Education & Clinical Center, William S. Middleton Veterans Hospital, Madison, Wisconsin.
authors.forename: Sterling C
authors.initials: SC
authors.lastname: Johnson
authors.affiliation: 7Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Waisman Laboratory for Brain Injury and Behavior, University of Wisconsin-Madison & Geriatric Research Education & Clinical Center, William S. Middleton Veterans Hospital, Madison, Wisconsin.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Berman
authors.affiliation: Departments of1Neurological Surgery and.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Wilbrand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000523:psychology*; D003071:Cognition; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging / Q000523:psychology; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000523:psychology; D015140:Dementia, Vascular / Q000000981:diagnostic imaging / Q000523:psychology; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000523:psychology*; D062706:Prodromal Symptoms; D012720:Severity of Illness Index; D014463:Ultrasonography; D066127:White Matter / Q000000981:diagnostic imaging
keywords: CA = carotid artery; CAS = CA stenosis; HITS = high-intensity transient signal; MCA = middle cerebral artery; TCD = transcranial Doppler; TIA = transient ischemic attack; WMH = white matter hyperintensity; carotid atherosclerosis; plaque instability; stroke; ultrasound; ultrasound strain; vascular cognitive decline; vascular disorders