Key result
Type III carotid plaques exhibit a high-risk ultrasound triad of vulnerability, increased thickness, and IPN.
Why the study?
The authors sought to establish a carotid plaque immune microenvironment classification system and explore whether multimodal ultrasound can non-invasively identify high-risk plaque subtypes.
Does multimodal ultrasound correlate with carotid plaque immune subtypes in patients undergoing carotid endarterectomy?
Observational (n=50)
Does multimodal ultrasound correlate with carotid plaque immune subtypes in patients undergoing carotid endarterectomy?
Multimodal ultrasound features, specifically vulnerability score and intraplaque neovascularization grade, correlate with high-risk immune subtypes of carotid plaques, offering a potential non-invasive risk stratification tool.
May support non-invasive carotid plaque stratification; hypothesis-generating and requires prospective validation.
RATIONALE AND OBJECTIVES: To establish a plaque immune microenvironment classification system and explore whether multimodal ultrasound may aid in the non-invasive identification of high-risk subtypes.This exploratory study investigated the association between PCA-derived immune subtypes and multimodal ultrasound features. METHODS: This prospective study included 50 patients undergoing carotid endarterectomy (CEA). Seven immunohistochemistry (IHC) markers: interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), IL-2, cluster of differentiation 11b (CD11b), myeloperoxidase (MPO), and microvessel density (MVD) were assessed. Principal component analysis (PCA) and hierarchical clustering defined immune subtypes. Preoperative conventional ultrasound and contrast-enhanced ultrasound (CEUS) evaluated vulnerability score, plaque thickness, and intraplaque neovascularization (IPN) grade. RESULTS: Hierarchical clustering revealed three functional modules: core pro-inflammatory (TNF-α, IL-6, IL-2, IFN-γ), angiogenesis-macrophage (CD11b, MVD), and MPO-alone. PCA classified 50 plaques into four subtypes: Type I (inflammation-dominated, n=8), Type II (angiogenesis-dominated, n=14), Type III (high inflammation and high angiogenesis, n=11), and Type IV (stable, n=17). Type III plaques had highest inflammatory factors and MVD, with 45.5% experiencing recent ischemic events. Ultrasound vulnerability score correlated with IL-6 (r=0.54) and MVD (r=0.52); IPN grade correlated strongly with MVD (r=0.69). Type III showed a "high-risk triad": high vulnerability score (median 5.0), increased thickness (0.45 cm), and high IPN grade (45.5% grade 3). Type II had isolated high IPN grade (71.4% ≥ grade 2). CONCLUSION: PCA-based immune subtyping of carotid plaques appears feasible. Multimodal ultrasound, particularly vulnerability score and IPN grade, may aid in the non-invasive identification of high-risk subtypes, suggesting a potential imaging strategy for plaque risk stratification.
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Liu et al. (2026) conducted an observational in Carotid plaques (n=50). PCA-derived immune subtypes vs. Different immune subtypes (Types I, II, III, IV) was evaluated on Association between PCA-derived immune subtypes and multimodal ultrasound features. Type III carotid plaques (high inflammation and angiogenesis) exhibited a high-risk ultrasound triad: high vulnerability score (median 5.0), increased thickness (0.45 cm), and high IPN grade.
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