The contribution of arterial ultrasound scanning to atherosclerotic cardiovascular risk stratification: Short review

In recent times, it has been recognized that atherosclerotic cardiovascular disease (ASCVD) risk stratification using algorithms such as Framingham risk score, prospective cardiovascular Munster, QRISK2 or SCORE2/SCORE2-OP which are based on conventional risk factors could be improved by ultrasound arterial scanning. In the past, much emphasis was placed on intima-media thickness (IMT), but two recent meta-analyses have demonstrated that IMT provides only a marginal improvement on risk factors. In contrast to IMT, the presence, thickness, area or volume of plaques at the carotid and/or common femoral bifurcations are the stronger independent predictors of future ASCVD events than conventional risk factors alone. A recent study has shown that the number of bifurcations with plaque, total plaque thickness (sum of thickness of larger plaque in each bifurcation), and total plaque area (sum of areas of all plaques present in four bifurcations) have a similar net reclassification improvement of 16.1%–16.7%. In addition to this, previous studies demonstrated that common femoral bifurcation plaques are the stronger predictors of risk than carotid plaques. Thus, as far as screening is concerned, it appears that the number of bifurcations with plaque would be sufficient. However, for clinical monitoring of the effect of therapy on plaque progression or regression, measurements of plaque area or volume are the most appropriate. The commercial availability of three-dimensional-probes for superficial vessels will now make measurements of plaque volume relatively easy and the ability to monitor plaque volume changes in a clinical setting possible.