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. 2020 Oct;39(10):2033-2042.
doi: 10.1002/jum.15311. Epub 2020 May 12.

Carotid Plaque Strain Indices Were Correlated With Cognitive Performance in a Cohort With Advanced Atherosclerosis, and Traditional Doppler Measures Showed no Association

Carol C Mitchell  1 , Stephanie M Wilbrand  2 , Thomas D Cook  3 , Nirvedh H Meshram  4   5   6 , Catherine N Steffel  4 , Rebecca Nye  1 , Tomy Varghese  4   5 , Bruce P Hermann  7 , Robert J Dempsey  2
Affiliations

Carotid Plaque Strain Indices Were Correlated With Cognitive Performance in a Cohort With Advanced Atherosclerosis, and Traditional Doppler Measures Showed no Association

Carol C Mitchell et al. J Ultrasound Med. 2020 Oct.

Abstract

Objectives: Traditional Doppler measures have been used to predict cognitive performance in patients with carotid atherosclerosis. Novel measures, such as carotid plaque strain indices (CPSIs), have shown associations with cognitive performance. We hypothesized that lower mean middle cerebral artery (MCA) velocities, higher bulb-internal carotid artery (ICA) velocities, the MCA pulsatility index (PI), and CPSIs would be associated with poorer cognitive performance in individuals with advanced atherosclerosis.

Methods: Neurocognitive testing, carotid ultrasound imaging, transcranial Doppler imaging, and carotid strain imaging were performed on 40 patients scheduled for carotid endarterectomy. Kendall tau correlations were used to examine relationships between cognitive tests and the surgical-side maximum peak systolic velocity (PSV; from the bulb, proximal, mid, or distal ICA), mean MCA velocity and PI, and maximum CPSIs (axial, lateral, and shear strain indices used to characterize plaque deformations with arterial pulsation). Cognitive measures included age-adjusted indices of verbal fluency, verbal and visual learning/memory, psychomotor speed, auditory attention/working memory, visuospatial construction, and mental flexibility.

Results: Participants had a median age of 71.0 (interquartile range, 9.75) years; 26 were male (65%), and 14 were female (35%). Traditional Doppler parameters, PSV, mean MCA velocity, and MCA PI did not predict cognitive performance (all P > .05). Maximum CPSIs were significantly associated with cognitive performance (P < .05).

Conclusions: Traditional velocity measurements of the maximum bulb-ICA PSV, mean MCA velocity, and PI were not associated with cognitive performance in patients with advanced atherosclerotic disease; however, maximum CPSIs were associated with cognitive performance. These findings suggest that cognition may be associated with unstable plaque rather than blood flow.

Keywords: carotid artery disease; cerebrovascular disease; vascular imaging/diagnostics.

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Figures

Figure 1.
Figure 1.. Trancranial Doppler Signal form the Middle Cerebral Arteries.
Doppler sample in the right and left middle cerebral arteries (R-MCA, LMCA). * Mean = mean velocity cm/s, Peak = peak systolic velocity cm/s, EDV = end diastolic velocity cm/s, PI = pulsatility index, RI = resistive index, S/D = systolic/diastolic ratio, HR = heart rate.
Figure 2.
Figure 2.. Internal Carotid Artery Doppler.
Doppler sample in the internal carotid artery. Peak systolic (PS) velocity −217.2 cm/s, end diastolic velocity (ED) 54.6 cm/s. Temporal average max (TAMx) = −104.5 cm/s, temporal average mean (TAMn) = −56.9 cm/s, pulsatility index = 1.56, resistive index = 0.75, systolic/diastolic (S/D) ratio = 3.98, acceleration time (T) = 0.025 seconds.
Figure 3.
Figure 3.. Carotid Axial Strain Image.
Carotid strain image. Axial strain in the segmented region overlaid on the corresponding B-mode.
Figure 4.
Figure 4.. Carotid Lateral Strain Image.
Carotid strain image. Lateral strain in the segmented region overlaid on the corresponding B-mode.
Figure 5.
Figure 5.. Carotid Shear Strain Image.
Carotid strain image. Shear strain in the segmented region overlaid on the corresponding B-mode.
See this image and copyright information in PMC

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