Key result
SMI-detected intraplaque flow is linked to plaque neovascularity and higher embolic risk during CAS.
Why the study?
Carotid artery stenting carries a risk of embolic cerebral infarction related to vulnerable plaque neovascularization, but detection of neovascularization in plaque has not been established.
Does superb micro-vascular imaging (SMI) detect neovascularization in carotid plaques and predict embolic events following carotid artery stenting in patients with severe carotid artery stenosis?
Does superb micro-vascular imaging (SMI) detect neovascularization in carotid plaques and predict embolic events following carotid artery stenting in patients with severe carotid artery stenosis?
Superb micro-vascular imaging (SMI) can detect intraplaque neovascularization, which may serve as a marker for plaque vulnerability and risk of embolic events during carotid artery stenting.
Warrants caution during carotid stenting in SMI-positive plaques; leaves open its utility for embolic risk prediction pending larger prospective studies.
Carotid artery stenting (CAS) was recommended for the treatment of severe carotid artery stenosis. One problem associated with CAS is cerebral infarction due to embolic events. Vulnerable plaque with bleeding and neovascularization is a risk factor for such events. Bleeding in plaque has been evaluated by ultrasonography and MRI. However, detection of neovascularization in plaque has not been established. We measured the intraplaque microcirculatory blood flow of 6 patients who underwent CAS with superb micro-vascular imaging (SMI). We compared the SMI signal and the embolic events following CAS. Case 3 had an SMI-positive signal with clear Doppler flow in the affected plaque; he subsequently showed plaque protrusion and asymptomatic embolic events. Another patient showed no Doppler signal. Doppler flow detected by SMI was found to be related to neovascularity of plaque. This finding might indicate the plaque vulnerability.
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中川 et al. (2020) studied this question. Intraplaque Doppler flow detected by superb micro-vascular imaging is associated with carotid plaque neovascularity and may indicate vulnerability to embolic events during stenting.
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