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Title: Identification of neovascularization by contrast-enhanced ultrasound to detect unstable carotid stenosis.
Authors: Schmidt, C
Fischer, T
Rückert, R-I
Oberwahrenbrock, T
Harms, L
Kronenberg, G
Kunte, H
First Published: 7-Apr-2017
Publisher: Public Library of Science
Citation: PLoS One, 2017, 12 (4), e0175331
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. CONCLUSION: 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.
DOI Link: 10.1371/journal.pone.0175331
eISSN: 1932-6203
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © the authors, 2017. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Description: Please also note that an extended data set containing information on clinical characteristics as well as immunohistological und CEUS parameters of individual patients has been appended as S1 Table.
Appears in Collections:Published Articles, Dept. of Cardiovascular Sciences

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