Carotid atherosclerotic plaque instability and cognition determined by ultrasound-measured plaque strain in asymptomatic patients with significant stenosis.
J Neurosurg
; 128(1): 111-119, 2018 01.
Article
in En
| MEDLINE
| ID: mdl-28298048
ABSTRACT
OBJECTIVE This article describes the use of ultrasound measurements of physical strain within carotid atherosclerotic plaques as a measure of instability and the potential for vascular cognitive decline, microemboli, and white matter changes. METHODS Asymptomatic patients with significant (> 60%) carotid artery stenosis were studied for dynamic measures of plaque instability, presence of microemboli, white matter changes, and vascular cognitive decline in comparison with normative controls and premorbid state. RESULTS Although classically asymptomatic, these patients showed vascular cognitive decline. The degree of strain instability measured within the atherosclerotic plaque directly predicted vascular cognitive decline in these patients thought previously to be asymptomatic according to classic criteria. Furthermore, 26% of patients showed microemboli, and patients had twice as much white matter hyperintensity as controls. CONCLUSIONS These data show that physical measures of plaque instability are possible through interpretation of ultrasound strain data during pulsation, which may be more clinically relevant than solely measuring degree of stenosis. The data also highlight the importance of understanding that the definition of symptoms should not be limited to motor, speech, and vision function but underscore the role of vascular cognitive decline in the pathophysiology of carotid atherosclerotic disease. Clinical trial registration no. NCT02476396 (clinicaltrials.gov).
Key words
CA = carotid artery; CAS = CA stenosis; HITS = high-intensity transient signal; MCA = middle cerebral artery; TCD = transcranial Doppler; TIA = transient ischemic attack; WMH = white matter hyperintensity; carotid atherosclerosis; plaque instability; stroke; ultrasound; ultrasound strain; vascular cognitive decline; vascular disorders
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Ultrasonography
/
Carotid Stenosis
/
Cognition
/
Plaque, Atherosclerotic
Type of study:
Clinical_trials
/
Diagnostic_studies
/
Prognostic_studies
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
J Neurosurg
Year:
2018
Document type:
Article