London, United Kingdom 2013 5 Vascular imaging 9:10 - 9:20 The significance of juxtaluminal carotid plaque echogenicity in the development of cere-brovascular Cerebrovasc Dis 2013; 35 (suppl 3)1-854 183 manifestations T.J. Tegos1, A. Petrakis2, A. Valavanis3, A. Safouris4, A. Papadimitriou5, A. Orologas6 A Neurology Department, AHEPA Hospital, Aristotelian University of Thessaloniki, Greece, Thessaloniki, GREECE1,A Neurology Department, AHEPA Hospital, Aristote-lian University of Thessaloniki, Greece, Thessaloniki, GREECE2, A Neurology Department, AHEPA Hospital, Aristotelian University of Thessaloniki, Greece, Thessaloniki, GREECE3, A Neurology Department, AHEPA Hospital, Aristotelian University of Thessaloniki, Greece, Thessaloniki, GREECE4, A Neurology Department, AHEPA Hospital, Aristotelian University of Thessaloniki, Greece, Thessaloniki, GREECE5, A Neurology Department, AHEPA Hospital, Aristotelian University of Thessaloniki, Greece, Thessaloniki, GREECE6 BACKGROUND: It has been demonstrated that the symptomatic carotid plaques are echolu-cent on ultrasound, whereas the asymptomatic ones are echogenic. The aim of this study was to determine whether the juxtaluminal plaque echogenicity (juxtaluminal 25% plaque area) con-stitutes a better discriminator of the symptomatic and asymptomatic status, as compared to the global plaque echogenicity. METHODS: The analysis involved imaging by duplex of 100 carotid plaques of more than 50% stenosis (88 patients,50 symptomatic and 50 asymptomatic plaques), capturing, digitisa-tion and normalisation in a computer in a standard way. The global plaque Grey Scale Median (GSMglobal) was evaluated to distinguish dark (low GSM) from bright (high GSM) plaques. Subsequently, juxtaluminal 25% plaque area GSM (GSMjl25%) was evaluated semi-quantita-tively in the same computer software. Stenosis was evaluated on duplex. RESULTS: Symptomatic plaques were associated with median GSMglobal of 6.5 whereas the asymptomatic ones of 32 (p=0.0001). The corresponding values for the median GSM-jl25% were: 0 for symptomatic plaques and 46.5 for asymptomatic ones (p=0.0001). ROC curves demonstrated a more adequate ability of GSMjl25% over GSMglobal in separating the symptomatic from the asymptomatic plaques (difference between areas: 0.104, p=0.001). Me-dian stenosis for the symptomatic plaques was 87.5% and for the asymptomatic ones 75 %( p=0.058). CONCLUSION: Our results suggested that the juxtaluminal 25% plaque echogenicity might have a more adequate ability over the global plaque echogenicity in separating symptomatic and asymptomatic carotid plaques. This position might be solidified in natural history studies of asymptomatic individuals with carotid plaques, having as an end point the development of stroke. 4 Vascular imaging 9:00 - 9:10 Is plaque neovascularisation detected by contrast enhanced ultrasound associated with symptomatic carotid artery disease? D. Artemis1, L. Schall2, M. Kablau3, M.G. Hennerici4, T. Riester5, R. Kern6 Department of Neurology, UniversitätsMedizin Mannheim, Mannheim, GERMANY1,Uni-versitätsMedizin Mannheim, Mannheim, GERMANY2, Department of Neurology, Universitäts- Medizin Mannheim, Mannheim, GERMANY3, Department of Neurology, UniversitätsMedizin Mannheim, Mannheim, GERMANY4, Department of Surgery, UniversitätsMedizin Mannheim, Mannheim, GERMANY5, Department of Neurology, UniversitätsMedizin Mannheim, Mann-heim, GERMANY6 Introduction: Among patients with carotid artery disease, it is very important to identify those with a particular high risk for stroke who may benefit from surgical or neuro-interventional therapy. Contrast enhanced ultrasound (CEUS) is a new diagnostic method that has been sug-gested to detect microbubbles within the plaque corresponding to plaque neovascularisation as a possible marker of “unstable”, vulnerable plaques. Methods: Native B-mode, color-coded and contrast enhanced carotid ultrasound examinations were performed in 50 symptomatic pa-tients (mean age 69+/-4.9 years, 26 male) and 16 asymptomatic (mean age 73+/-8.5 years, 14 male) with significant (>50%) carotid artery stenosis. According to predefined criteria findings were evaluated for plaque echogenicity on B-mode, and for presence of plaque neovasculariza-tion or micro-ulcerations using CEUS. Results: Plaque neovascularisation was similarly dis-tributed among symptomatic and asymptomatic carotid plaques (24% vs. 25% of the plaques (p=0,193.). The presence of plaque neovascularisation on CEUS was associated with arterial hypertension (p=0.04) but not with smoking (p=0.13), dyslipidaemia (p=0.85) or diabetes mel-litus (p=0.63). Symptomatic plaques had significantly more often components with low echo-genicity on B-mode imaging (ρ=0.015). Conlusion: Symptomatic stenoses of the carotid artery mostly consisted of echolucent plaques. Whether or not this reflected a postembolic stage or a condition at risk different from asymptomatic plaque remains uncertain. In the present analysis, however, plaque neovascularisation identified by CEUS was not associated with symptomatic carotid stenosis.
Karger_ESC London_2013
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