Advanced Ultrasound Methods in the Assessment of Carotid Plaque Instability
Advanced Ultrasound Methods in the Assessment of Carotid Plaque Instability
The primary aim of this project is to assess if advanced ultrasound methods such as SMI
 (Superb microvascular Imaging) and SWE (Shear Wave Elastography) can identify intraplaque
 neovascularization and plaque tissue stiffness in carotid artery plaques and relate these
 results to ipsilateral cerebrovascular symptoms.

 The secondary aim of this project is to assess the level of agreement between the structural
 plaque characteristics assessed by advanced ultrasound examinations such as SMI, SWE, CEUS
 (Contrast enhanced ultrasound), GSM (Plaque gray-scale-median) and carotid MRI, metabolic
 activity of plaque assessed by 18F-FDG PET/CT with histology as the gold standard. Findings
 from the methods mentioned above will be related to cerebrovascular symptoms, blood tests
 (cholesterol-tot, LDL, HDL, CRP, leukocytes, glucose, HbA1c) and other cardiovascular risk
 factors at inclusion and upon 1 year follow up.
The project will include 3 studies:

 Study 1:

 Analyse the correlation between SMI assessed neovascularization and degree of stenosis in
 symptomatic patients with high-grade (>50%) carotid stenosis versus asymptomatic patients
 with high-grade (>50%) carotid stenosis.

 All patients upon inclusion will undergo:

 -  Clinical, neurological evaluation

 -  Blood tests

 -  SMI, CEUS and SWE ultrasound

 -  Carotid MRI

 -  PET (subgroup)

 -  DW-MRI

 -  Histological assessments after the removal of plaque at carotid endarterectomy (CEA).

 Study 2:

 SMI and vascular events. Asymptomatic patient's follow-up at 12 months:

 -  Clinical neurological evaluation

 -  Blood test

 -  SMI, CEUS, SWE ultrasound

 -  Carotid MRI

 -  PET (subgroup)

 Study 3:

 This study will use the same patient pool described in study 1 undergoing the previously
 described procedural examinations upon inclusion and at one year follow up. Quantification of
 stiffness/elasticity in the artery wall will be performed and compared to plaque echogenicity
 measured as GSM . These results will be correlated to histology of the carotid plaque after
 trombendarterectomy, risk markers in blood (lipids, HbA1c, CRP, leukocytes), other
 cardiovascular risk markers (hypertension, diabetes, nicotine) and cerebrovascular symptoms.
Inclusion Criteria:

 -  Atherosclerotic carotid stenosis >50% with or without cerebrovascular symptoms.

 Exclusion Criteria:

 -  Malignancies

 -  Inflammatory disease