Coli Stefano, Magnoni Marco, Sangiorgi Giuseppe, Marrocco-Trischitta Massimiliano M, Melisurgo Giulio, Mauriello Alessandro, Spagnoli Luigi, Chiesa Roberto, Cianflone Domenico, Maseri Attilio
Department of Cardiothoracic and Vascular Diseases, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.
J Am Coll Cardiol. 2008 Jul 15;52(3):223-30. doi: 10.1016/j.jacc.2008.02.082.
This study was designed to evaluate contrast-enhanced ultrasound imaging of carotid atherosclerosis as a clinical tool to study intraplaque neovascularization.
Plaque neovascularization is associated with plaque vulnerability and symptomatic disease; therefore, imaging of neovascularization in carotid atherosclerosis may represent a useful tool for clinical risk stratification and monitoring the efficacy of antiatherosclerotic therapies.
Thirty-two patients with 52 carotid plaques were studied by standard and contrast-enhanced ultrasound imaging. In 17 of these patients who underwent endarterectomy, the surgical specimen was available for histological determination of microvessel density by CD31/CD34 double staining. Plaque echogenicity and degree of stenosis at standard ultrasound imaging were evaluated for each lesion. Contrast-agent enhancement within the plaque was categorized as absent/peripheral (grade 1) and extensive/internal (grade 2).
In the surgical subgroup, plaques with higher contrast-agent enhancement showed a greater neovascularization at histology (grade 2 vs. grade 1 contrast-agent enhancement: median vasa vasorum density: 3.24/mm(2) vs. 1.82/mm(2), respectively, p = 0.005). In the whole series of 52 lesions, echolucent plaques showed a higher degree of contrast-agent enhancement (p < 0.001). Stenosis degree was not associated with neovascularization at histology or with the grade of contrast-agent enhancement.
Carotid plaque contrast-agent enhancement with sonographic agents correlates with histological density of neovessels and is associated with plaque echolucency, a well-accepted marker of high risk lesions, but it is unrelated to the degree of stenosis. Contrast-enhanced carotid ultrasound imaging may provide valuable information for plaque risk stratification and for assessing the response to antiatherosclerotic therapies, beyond that provided by standard ultrasound imaging.
本研究旨在评估颈动脉粥样硬化的超声造影成像作为研究斑块内新生血管形成的临床工具。
斑块新生血管形成与斑块易损性及症状性疾病相关；因此，颈动脉粥样硬化中新生血管形成的成像可能是临床风险分层及监测抗动脉粥样硬化治疗疗效的有用工具。
对32例患者的52个颈动脉斑块进行标准超声成像和超声造影成像研究。其中17例接受了内膜切除术的患者，手术标本可用于通过CD31/CD34双重染色进行微血管密度的组织学测定。对每个病变在标准超声成像时的斑块回声及狭窄程度进行评估。斑块内造影剂增强分为无/周边（1级）和广泛/内部（2级）。
在手术亚组中，造影剂增强较高的斑块在组织学上显示出更大的新生血管形成（造影剂增强2级与1级相比：微血管密度中位数分别为3.24/mm²和1.82/mm²，p = 0.005）。在整个52个病变系列中，低回声斑块显示出更高程度的造影剂增强（p < 0.001）。狭窄程度与组织学上的新生血管形成或造影剂增强等级无关。
超声造影剂增强的颈动脉斑块与新生血管的组织学密度相关，且与斑块低回声相关，低回声是公认的高危病变标志物，但与狭窄程度无关。超声造影增强的颈动脉超声成像可能为斑块风险分层及评估抗动脉粥样硬化治疗反应提供有价值的信息，这超出了标准超声成像所提供的信息。
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