Carotid intima-media thickness and asymptomatic plaques detected by ultrasound predict coronary, cerebrovascular, and peripheral arterial disease and improve cardiovascular risk estimation.
Does carotid IMT measurement and plaque detection improve risk prediction for cardiovascular events?
Non-invasive ultrasound detection of carotid IMT and plaques serves as a valuable tool for early detection of polyvascular disease and improves individual cardiovascular risk assessment.
Carotid atherosclerotic lesions are correlated with atherosclerotic deterioration of the arterial wall in other vascular territories and with cardiovascular events. The detection of pre-symptomatic carotid lesions like intima-media thickness (IMT) and asymptomatic carotid plaques is possible by non-invasive ultrasound duplex scanning. Current measurement guidelines suggest an average measurement of IMT within 10 mm of the segment of the common carotid artery. The thickening of intima-media appears in a long subclinical period of atherosclerosis. Therefore, the determination of IMT has emerged as one of the methods for determining early structural deterioration of the arterial wall. A close interrelationship was shown between IMT and risk factors of atherosclerosis, their duration, and intensity. Different studies demonstrated that increased IMT is a powerful predictor of coronary, cerebrovascular, and peripheral arterial occlusive disease and their complication. A recent meta-analysis indicated a minimal improvement in the risk estimation of cardiovascular events after adding IMT to the Framingham Risk Score. These findings influenced the latest ACC/AHA guidelines which again recommend the use of carotid IMT measurement for individual risk assessment. The presence of atherosclerotic plaques indicates that the atherosclerotic process is already ongoing. The findings of different studies are equivocal that carotid plaques independently predict cardiovascular events and improve risk predictions for coronary artery disease when added to the Framingham Risk Score. However, besides the size of plaque and grade of stenosis, the structure of plaque calcification, vascularization, lipid core, and the surface of plaques are important indicators of related risks for cardiovascular events.
Poredoš et al. (Thu,) conducted a review in Preclinical carotid atherosclerosis. Carotid ultrasound duplex scanning (IMT and plaque detection) was evaluated. Carotid intima-media thickness and asymptomatic plaques detected by ultrasound predict coronary, cerebrovascular, and peripheral arterial disease and improve cardiovascular risk estimation.