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1. Contrast Enhanced Ultrasound (CEUS) Is Not Able to Identify Vulnerable Plaques in Asymptomatic Carotid Atherosclerotic Disease.

Author

D'Oria M, Chiarandini S, Pipitone MD, Fisicaro M, Calvagna C, Bussani R, Rotelli A, and Ziani B

Subjects
Aged, Aged, 80 and over, Carotid Arteries pathology, Carotid Artery Diseases pathology, Endarterectomy, Carotid methods, Female, Humans, Male, Middle Aged, Plaque, Atherosclerotic pathology, Carotid Arteries surgery, Carotid Artery Diseases surgery, Contrast Media, Neovascularization, Pathologic surgery, Plaque, Atherosclerotic surgery
Abstract

Objectives: Contrast enhanced ultrasound (CEUS) has been suggested as an imaging tool for detection of asymptomatic carotid atherosclerotic disease (ACAD) at high risk of cerebral embolisation. The objective of this study was to evaluate CEUS and immunohistochemical (IHC) patterns in ACAD (i.e., without any neurologic symptoms in the last 6 months) and their correlations with histology., Methods: CEUS analysis was classified on a semiquantitative basis using a three-point classification scale. Plaque morphology was assessed using the American Heart Association (AHA) classification of atherosclerotic plaques, then accordingly assigned as non-vulnerable (AHA Type IV/V) or vulnerable (AHA Type VI). IHC analysis for intra-plaque neo-angiogenesis (IPN) was identified by CD34/VEGF immunostaining and classified on a semiquantitative basis using a four-point classification scale. Both CEUS and IHC analyses were performed and scored by single observers., Results: Fifty-eight consecutive asymptomatic patients (mean age 73 years, 33 males) undergoing carotid endarterectomy were included in the final analysis. Nineteen had AHA Class IV/V plaques, and the remaining 39 had AHA Class VI plaques. There were two main findings of the study: (a) histologically proven vulnerable plaques compared with histologically proven non-vulnerable plaques had denser IPN (p = .004), but did not show more pronounced contrast enhancement; (b) the correlation between IHC analysis and CEUS analysis was significant for both vulnerable and non-vulnerable plaques (p = .04 and p = .01, respectively), but it was direct for AHA Type IV/V plaques and inverse for AHA Type VI plaques., Conclusions: The main findings of the study were that histologically proven vulnerable plaques (i.e., AHA Class VI) as compared with histologically proven non-vulnerable plaques (i.e., AHA Class IV/V) had denser neo-vascularisation, but not more pronounced contrast enhancement., (Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Published
2018
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2. Contrast Enhanced Ultrasound (CEUS) Is Not Able to Identify Vulnerable Plaques in Asymptomatic Carotid Atherosclerotic Disease

Author

Stefano Chiarandini, Marco Pipitone, Rossana Bussani, Mario D'Oria, Alice Rotelli, Barbara Ziani, Fisicaro M, Cristiano Calvagna, D'Oria, Mario, Chiarandini, Stefano, Pipitone, Marco D., Fisicaro, Maurizio, Calvagna, Cristiano, Bussani, Rossana, Rotelli, Alice, and Ziani, Barbara

Subjects
Carotid Artery Diseases, Male, Pathology, medicine.medical_specialty, medicine.medical_treatment, CD34, Contrast Media, Carotid endarterectomy, 030204 cardiovascular system & hematology, medicine.disease_cause, Asymptomatic, Asymptomatic carotid atherosclerotic disease, 03 medical and health sciences, 0302 clinical medicine, Intraplaque neoangiogenesis, medicine, Humans, Contrast-enhanced ultrasound, Vulnerable plaque, Surgery, Cardiology and Cardiovascular Medicine, health care economics and organizations, Aged, Aged, 80 and over, Endarterectomy, Carotid, Neovascularization, Pathologic, business.industry, Histology, Middle Aged, Intraplaque neoangiogenesi, Plaque, Atherosclerotic, Carotid Arteries, Immunohistochemistry, Female, medicine.symptom, business, 030217 neurology & neurosurgery, Immunostaining
Abstract

Objectives Contrast enhanced ultrasound (CEUS) has been suggested as an imaging tool for detection of asymptomatic carotid atherosclerotic disease (ACAD) at high risk of cerebral embolisation. The objective of this study was to evaluate CEUS and immunohistochemical (IHC) patterns in ACAD (i.e., without any neurologic symptoms in the last 6 months) and their correlations with histology. Methods CEUS analysis was classified on a semiquantitative basis using a three-point classification scale. Plaque morphology was assessed using the American Heart Association (AHA) classification of atherosclerotic plaques, then accordingly assigned as non-vulnerable (AHA Type IV/V) or vulnerable (AHA Type VI). IHC analysis for intra-plaque neo-angiogenesis (IPN) was identified by CD34/VEGF immunostaining and classified on a semiquantitative basis using a four-point classification scale. Both CEUS and IHC analyses were performed and scored by single observers. Results Fifty-eight consecutive asymptomatic patients (mean age 73 years, 33 males) undergoing carotid endarterectomy were included in the final analysis. Nineteen had AHA Class IV/V plaques, and the remaining 39 had AHA Class VI plaques. There were two main findings of the study: (a) histologically proven vulnerable plaques compared with histologically proven non-vulnerable plaques had denser IPN (p = .004), but did not show more pronounced contrast enhancement; (b) the correlation between IHC analysis and CEUS analysis was significant for both vulnerable and non-vulnerable plaques (p = .04 and p = .01, respectively), but it was direct for AHA Type IV/V plaques and inverse for AHA Type VI plaques. Conclusions The main findings of the study were that histologically proven vulnerable plaques (i.e., AHA Class VI) as compared with histologically proven non-vulnerable plaques (i.e., AHA Class IV/V) had denser neo-vascularisation, but not more pronounced contrast enhancement.

Published
2018

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