title: Identification of neovascularization by contrast-enhanced ultrasound to detect unstable carotid stenosis.
abstract: BACKGROUND
  Plaque neovascularization accompanies local inflammation and critically contributes to plaque instability. Correct identification of intraplaque neovascularization by contrast-enhanced ultrasound (CEUS) may provide an additional risk marker in carotid stenosis. This pilot study investigates the correlation between histological evaluation of carotid plaque specimens and pre-surgery CEUS to identify neovascularization.
  
  
  METHODS
  17 patients with high-grade internal carotid artery (ICA) stenosis were studied. CEUS was performed in all patients shortly before carotid endarterectomy. Neovascularization, infiltration of T cells and macrophages along with intraplaque hemorrhage were studied in excised plaques by immunohistochemistry. Ultrasound-based four-level and two-level classification systems for neovascularization were used. CEUS findings were compared with histological findings.
  
  
  RESULTS
  Scores on the CEUS-based four-level and two-level classifications were robustly correlated with the density of intraplaque vessels (r = 0.635, p = 0.006 and r = 0.578, p = 0.015, respectively). Histological evaluation of regions with strong and prolonged intraplaque enhancement typically showed strong intraplaque neovascularization in conjunction with acute intraplaque hemorrhage. Moreover, higher grades of intraplaque neovascularization as determined by ultrasound were associated with a higher percentage of macrophage-rich areas.
  
  
  CONCLUSIONS
  CEUS is a technique well suited to gauge the degree of neovascularization of carotid plaques. Future research will have to define the reliability and validity of CEUS in everyday clinical practice. Further, our study suggests that CEUS may also be useful to pick up features of vulnerable plaques such as acute intraplaque hemorrhages.
authors.affiliation: Charité Center 15 for Neurology, Neurosurgery and Psychiatry, Charité -Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Schmidt
authors.affiliation: Institute of Radiology, Charité -Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fischer
authors.affiliation: Franziskus Krankenhaus Berlin, Berlin, Germany.
authors.forename: Ralph-Ingo
authors.initials: RI
authors.lastname: Rückert
authors.affiliation: NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Timm
authors.initials: T
authors.lastname: Oberwahrenbrock
authors.affiliation: Charité Center 15 for Neurology, Neurosurgery and Psychiatry, Charité -Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Harms
authors.affiliation: Charité Center 15 for Neurology, Neurosurgery and Psychiatry, Charité -Universitätsmedizin Berlin, Berlin, Germany.|Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für Nervenheilkunde, Universitätsmedizin Rostock, Rostock, Germany.
authors.forename: Golo
authors.initials: G
authors.lastname: Kronenberg
authors.affiliation: Charité Center 15 for Neurology, Neurosurgery and Psychiatry, Charité -Universitätsmedizin Berlin, Berlin, Germany.|MSB Medical School Berlin, Berlin, Germany.
authors.forename: Hagen
authors.identifier: http://orcid.org/0000-0002-6609-6995
authors.initials: H
authors.lastname: Kunte
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000150:complications / Q000000981:diagnostic imaging*; D014463:Ultrasonography
chemical_list: D003287:Contrast Media