Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology, Nara Medical University, Nara, Japan.
Department of Neurology, Nara Medical University, Nara, Japan; Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan.
Ultrasound Med Biol. 2023 Aug;49(8):1798-1803. doi: 10.1016/j.ultrasmedbio.2023.04.002. Epub 2023 May 16.
This study was aimed at assessing intraplaque neovessels, focusing on neovascularization from the vascular luminal side using contrast-enhanced ultrasound (CEUS) and determining that this contrast effect indicates that the neovessel is connected to the vessel lumen histopathologically. Whether plaque vulnerability can be assessed more accurately was also investigated.
We enrolled consecutive patients with internal carotid artery stenosis who underwent carotid endarterectomy (CEA) and pre-operative CEUS with perflubutane of the carotid arteries. We graded the contrast effect semi-quantitatively from the vascular luminal and adventitial sides. We compared the contrast effect with the pathological findings, especially the neovascularization of the CEA specimens.
In total, 68 carotid arterial atheromatous plaques (47 symptomatic) were analyzed. Symptomatic plaques were significantly correlated with stronger contrast effects from the luminal side than from the adventitial side (p = 0.0095). Microbubbles from the luminal side appeared to flow mainly into the plaque shoulder. The contrast effect value for the plaque shoulder and neovessel density were significantly correlated (ρ = 0.35, p = 0.031). Neovessel density was significantly higher in symptomatic than in asymptomatic plaques (56.2 ± 43.7/mm and 18.1 ± 15.2/mm, respectively, p < 0.0001). Serial histological sections of CEA specimens in a symptomatic plaque with a strong contrast effect from the luminal side revealed multiple neovessels fenestrated to the vessel lumen with endothelial cells, consistent with the CEUS findings.
Contrast-enhanced ultrasound can be used to evaluate neovessels originating from the luminal side, histopathologically confirmed in serial sections. Symptomatic vulnerable plaque is correlated more significantly with intraplaque neovascularization from the luminal side than with neovascularization from the adventitia.
本研究旨在评估斑块内新生血管，重点关注使用对比增强超声（CEUS）从血管腔内侧评估新生血管化，并确定这种对比效应表明新生血管在组织病理学上与血管腔相连。还研究了是否可以更准确地评估斑块易损性。
我们连续纳入了接受颈动脉内膜切除术（CEA）和颈动脉术前泛氟烷 CEUS 的颈内动脉狭窄患者。我们从血管腔内侧和外侧对对比效果进行半定量评分。我们将对比效果与病理发现进行了比较，特别是 CEA 标本的新生血管化。
共分析了 68 个颈动脉粥样硬化斑块（47 个有症状）。有症状的斑块与从腔内侧观察到的更强的对比效果显著相关（p=0.0095）。从腔内侧出现的微泡似乎主要流入斑块肩部。斑块肩部的对比效果值与新生血管密度显著相关（ρ=0.35，p=0.031）。有症状的斑块的新生血管密度明显高于无症状的斑块（分别为 56.2±43.7/mm 和 18.1±15.2/mm，p<0.0001）。在一个从腔内侧观察到强对比效果的有症状斑块的 CEA 标本的连续组织学切片中，发现多个新生血管有内皮细胞通向血管腔，与 CEUS 结果一致。
对比增强超声可用于评估起源于腔内侧的新生血管，在连续切片中得到组织病理学证实。有症状的易损斑块与从腔内侧起源的斑块内新生血管化的相关性比与从外侧起源的相关性更显著。
