Advanced ultrasound evaluation of vulnerable carotid artery plaque: Can a combined two-dimensional and three-diminsional plaque imaging analysis identify significant plaque characteristics responsible for strokes? A case series study

Objectives: Imaging carotid plaque morphology with the use of ultrasound (US) may improve stroke risk management by identifying alterations in atheroma at increased risk for cerebrovascular events. Limited reports on advanced US plaque imaging have identified the potential for evaluation and risk stratification of vulnerable carotid plaques. The purpose of this series was to evaluate the usefulness of integrating an advanced US plaque imaging method to characterize atheromas and to measure the agreement with multidetector row computed tomography (CT) and radiographic pathology.
Methods: Three patients with known high-grade symptomatic carotid artery disease confirmed on CT and scheduled for endarterectomy were recruited for this study. Before surgery, we prospectively assessed carotid arteries for high-risk morphological characteristics using our advanced US plaque imaging mechanism. The plaque characteristics considered included the presence of ulceration, internal lipid or hemorrhagic core(s), calcification(s), and/or thin/dense fibrous plaque caps. US plaque features were correlated with previous CT imaging and postendartertectomy histologic studies.
Results:There was substantial agreement in the detection ofmorphologic characteristics. Our advanced US method yielded100% sensitivity, specificity, and accuracy in the identification of ul-ceration, lipid/hemorrhagic core(s) and calcification(s), leading overCT. In the identification of a thin/dense fibrous plaque cap, CTyielded 0% sensitivity versus 33% on US.
Conclusions: Advanced US plaque imaging to further identify signif-icant plaque abnormalities responsible for strokes can reliably identifyvulnerable plaque characteristics on both two-dimensional and three-dimensional US. Our results suggest that the type of abnormality iden-tified with our advanced US imaging method surpassed informationgathered on CT. Our advanced imaging protocol shows potentialfor early noninvasive prediction of plaque vulnerability, thusimproving preventive management of atherosclerosis.