Detection of Unstable Plaques in Patients with Carotid Stenosis using B-Mode Ultrasonography

Abstract

Distal embolism is a detrimental complication of stent placement for the carotid artery stenosis. To evaluate usefulness of B-mode ultrasonography (US) for the detection of unstable plaques in patients with carotid artery stenosis, we examined US in 46 arteries of 35 patients with carotid stenosis of > 30%. The echogenicity of 46 carotid plaques was hyperechoic in 20 plaques, hypoechoic in 15, and mixed-echoic in 11. The echogenicity of carotid plaques was correlated with severity of carotid stenosis, ipsilateral stroke or TIA, heart attack, and risk factors of systemic atherosclerosis. Hypoechoic plaques were associated with severe carotid stenosis and ipsilateral ischemic event. Mixed-echoic plaques had a high incidence of past history of heart attack. Hyperechoic plaques were less likely to associate with risk factors of systemic atherosclerosis. We developed a new method of echodensity analysis. Using a computer software, echodensity values of seven plaque components were determined by comparing US findings and pathology of surgical specimens. The echodensity value was defined as a relative value to the arterial lumen. The calcified part of plaques had the highest echodensity of 6.24 +/- 0.86 (mean +/- 2 S.D.); fibrosis or hyarynoid degeneration of 2.05 +/- 0.40, foamy histiocytes of 1.47 +/- 0.05, necrosis of 1.32 +/- 0.16, cholestelin clefts of 1.28 +/- 0.13, intraplaque hemorrhage of 1.02 +/- 0.09, and intraluminal thrombus of 1.27 +/- 0.07. Constructed from the echodensity value, an echo-densitometry color mapping of the carotid plaque illustrated the exact location and extent of plaque component. B-mode US of carotid plaques represents clinical characteristics relating distal embolism and systemic atherosclerosis. A new method of echodensity analysis and echo-densitometry color mapping of the carotid plaque is useful to detect unstable plaques in patients with carotid stenosis.

Figure 1

B-mode US scan (right) and corresponding surgical specimen (left). The echodensity of each plaque component is determined using computer software.

Figure 2

Relationship between plaque echogenicity and severity of carotid stenosis. Severe stenosis is common in hypoechoic lesions.

Figure 3

Echodensity value of plaque components. The echodensity value is defined as the relative value to the arterial lumen (mean value ± 2 S.D.).

Figure 4

Echo-densitometry color mapping of carotid plaque. The color mapping demonstrates the precise structure of plaque. The part of foamy histiocytes, necrosis and cholestelin clefts is expressed as “soft plaque” because these components provide the same echodensity.