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NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS
Official Journal of the Bulgarian Society of Neurosonology and Cerebral Hemodynamics
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texts with exact phrase : '
carotid plaque
'.
1.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, Vol. 1, 2005
,
,
,
Classical topics such as
carotid
plaque
characterization, emboli detection monitoring, ultrasound contrast imaging, ultrasound diagnosis of foramen ovale, ultrasound application during
carotid
surgery and functional assessment of cerebral hemodynamics were also presented.
The 10th Meeting of the European Society of Neurosonology and Cerebral Hemodynamics (ESNCH) focused the attention in different topics. Specific sessions were devoted to emerging problems as the role of the ultrasounds in stroke units (perfusion imaging and sonothrombolysis) is known to be very important. Ultrasounds in non vascular brain diseases, hyperbaric medicine, imaging brain parenchyma and cerebral venous system were another innovative topics along with arterial wall imaging including intima-media tichkness (IMT) and distensibility studies.
Classical topics such as carotid plaque characterization, emboli detection monitoring, ultrasound contrast imaging, ultrasound diagnosis of foramen ovale, ultrasound application during carotid surgery and functional assessment of cerebral hemodynamics were also presented.
The advance in neurosonology, connected with echo-contrast bolus traking for analysis of cerebral circulation time, the assessment of the global cerebral blood volume and ultrasound evaluation of movement disorders, was discussed in a separate session. Proper time was dedicated to training and certification in Neurosonology in the European community.
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2.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 1, 2005, No. 2
,
,
,
Noninvasive imaging of
carotid
plaque
inflammation.
Trivedi R, King U, Graves M, et al.
Noninvasive imaging of carotid plaque inflammation.
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Microembolic signals and
carotid
plaque
morphology: a study of 71 patients with moderate or high grade
carotid
stenosis.
Mayor I, Comelli M, Vassileva E, Burkhard P, Sztajzel R.
Microembolic signals and carotid plaque morphology: a study of 71 patients with moderate or high grade carotid stenosis.
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Ultrasonographic features of
carotid
plaque
and the risk of subsequent neurologic deficits.
Sterpetii A, Schultz R, Feldhaus R, Davenport K, Richardson M, Farina C, Hunter J.
Ultrasonographic features of carotid plaque and the risk of subsequent neurologic deficits.
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3.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 2, 2006, No. 1
,
,
,
Plasma homocyst(e)ine concentration, but not MTHFR genotype, is associated with variation in
carotid
plaque
area.
Spence JD, Malinow MR, Barnett PA, Marian AJ, Freeman D, Hegele RA.
Plasma homocyst(e)ine concentration, but not MTHFR genotype, is associated with variation in carotid plaque area.
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4.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 3, 2007, No. 1
,
,
,
Carotid
plaque
, aging, and risk factors.
Fabris F, Zanocchi M, Bo M, Fonte G, Poli L, Bergoglio I, Ferrario E, Pernigotti L.
Carotid plaque, aging, and risk factors.
A study of 457 subjects. Stroke. Fabris F, Zanocchi M, Bo M, Fonte G, Poli L, Bergoglio I, Ferrario E, Pernigotti
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L.
Carotid
plaque
, aging, and risk factors.
L. Carotid plaque, aging, and risk factors.
A study of 457 subjects.
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5.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 7, 2011, No. 1
,
,
,
Management of mobile floating
carotid
plaque
using
carotid
artery stenting.
Chakhtoura EY, Goldstein JE, Hobson RW.
Management of mobile floating carotid plaque using carotid artery stenting.
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Doppler and M mode sonography of mobile
carotid
plaque
.
Kotval PS, Barakat K.
Doppler and M mode sonography of mobile carotid plaque.
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6.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 2, 2012, No. 2
,
,
,
Future ideas were revealed in the rich variety of lectures covering topics in various sessions: “Heart and Mind” (arterial fibrillations in stroke, role of Neurosonology in the therapeutic approach in patients with asymptomatic
carotid
pathology, correlation between
carotid
pathology and cardiovascular diseases), “Unstable
Carotid
Plaque
“(identification of the stability of
carotid
plaques by duplex scanning, assessment of their vascularization, risk of stroke, etc.), “Neuromyosonology” and others.
E. Ringelstein (Germany), K. Niederkorn (Austria), E. Bartels (Germany) and others.
Future ideas were revealed in the rich variety of lectures covering topics in various sessions: “Heart and Mind” (arterial fibrillations in stroke, role of Neurosonology in the therapeutic approach in patients with asymptomatic carotid pathology, correlation between carotid pathology and cardiovascular diseases), “Unstable Carotid Plaque “(identification of the stability of carotid plaques by duplex scanning, assessment of their vascularization, risk of stroke, etc.), “Neuromyosonology” and others.
In this session, Professor E. Ti-
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7.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 9, 2013, No. 2
,
,
,
Measurement of
Carotid
Plaque
Volume with VOCALTMII Technique by 3-Dimensional Ultrasound.
Measurement of Carotid Plaque Volume with VOCALTMII Technique by 3-Dimensional Ultrasound.
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Juxtaluminal Echogenicity as a Marker of
Carotid
Plaque
Instability.
Juxtaluminal Echogenicity as a Marker of Carotid Plaque Instability.
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B-mode
carotid
ultrasound has been widely used to detect subclinical
carotid
atherosclerosis by quantifying
carotid
intima–media thickness (cIMT) and
carotid
plaque
(CP).
Carotid atherosclerotic disease plays a large role in the etiology of stroke.
B-mode carotid ultrasound has been widely used to detect subclinical carotid atherosclerosis by quantifying carotid intima–media thickness (cIMT) and carotid plaque (CP).
Both cIMT and CP have been accepted surrogate imaging biomarkers of subclinical atherosclerosis until recently when it became increasingly clear that cIMT and CP may be genetically and biologically distinct atherosclerotic phenotypes with evidence of heterogeneous etiology. In addition, carotid atherosclerotic plaque burden, defined as the
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carotid
atherosclerosis,
carotid
IMT,
carotid
plaque
.
carotid atherosclerosis, carotid IMT, carotid plaque.
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Multisequence MRI is able to quantify
carotid
plaque
components.
Symptomatic patients with microembolic signals (MES), assessed by TCD, have been shown to be at high risk for developing ipsilateral stroke. Whether MES positive asymptomatic patients also are at increased risk has not been clarified. The use of ultrasound contrast agents may be helpful in determining plaque surface and plaque neovascularization.
Multisequence MRI is able to quantify carotid plaque components.
The use of a contrast agent improves quantification of total plaque burden, and contrast between fibrous cap and lipid core. Dynamic contrast-enhanced MRI allows assessment of plaque neovascularization.
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MEASUREMENT OF
CAROTID
PLAQUE
VOLUME WITH VOCALTMII TECHNIQUE BY 3-DIMENSIONAL ULTRASOUND
MEASUREMENT OF CAROTID PLAQUE VOLUME WITH VOCALTMII TECHNIQUE BY 3-DIMENSIONAL ULTRASOUND
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Measurement of
carotid
plaque
volume and its progression are important tools for research and patient management.
Measurement of carotid plaque volume and its progression are important tools for research and patient management.
In this study, we investigate the observer reproducibility in the measurement of plaque volume as determined with VOCALTMII technique by 3-dimensional (3D) ultrasound (US). We also investigate the effect of plaque size and position on measurement reproducibility.
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Intraand inter-observer variabilities were small for measurement of
Carotid
Plaque
Volume with VOCALTMII technique by 3-Dimensional Ultrasound.
Intraand inter-observer variabilities were small for measurement of Carotid Plaque Volume with VOCALTMII technique by 3-Dimensional Ultrasound.
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carotid
plaque
volume, 3-dimensional ultrasound.
carotid plaque volume, 3-dimensional ultrasound.
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JUXTALUMINAL ECHOGENICITY AS A MARKER OF
CAROTID
PLAQUE
INSTABILITY
JUXTALUMINAL ECHOGENICITY AS A MARKER OF CAROTID PLAQUE INSTABILITY
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carotid
,
plaque
, stroke, ultrasound.
carotid, plaque, stroke, ultrasound.
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8.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 11, 2015, No. 2
,
,
,
Data were collected on vascular risk factors (hypertension, diabetes, dyslipidemia, smoking), as well as on the possible association between right-to-left cardiac shunt with changes in the
carotid
arteries (
carotid
intima-media thickness (CIMT), the presence of
carotid
plaque
) and the presence of deep venous thrombosis (DVT).
We conducted a retrospective review of de-identified reports from 58 patients with positive TCD that were subsequently subjected to c-TEE examination.
Data were collected on vascular risk factors (hypertension, diabetes, dyslipidemia, smoking), as well as on the possible association between right-to-left cardiac shunt with changes in the carotid arteries (carotid intima-media thickness (CIMT), the presence of carotid plaque) and the presence of deep venous thrombosis (DVT).
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Carotid
plaque
right
Carotid plaque right
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Carotid
plaque
left
Carotid plaque left
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Carotid
plaque
both sides
Carotid plaque both sides
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9.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 12, 2016, No. 1
,
,
,
Features of unstable
carotid
plaque
during and after the hyperacute period following TIA/stroke.
Salem MK, Sayers RD, Bown MJ, West K, Moore D, Robinson TG, Naylor AR.
Features of unstable carotid plaque during and after the hyperacute period following TIA/stroke.
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10.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 13, 2017, No. 1
,
,
,
However, a recently published meta-analysis of 11 population-based studies has shown that the ultrasound assessment of
carotid
plaque
has a significantly higher accuracy for predicting future myocardial infarction or CAD events compared with
carotid
IMT assessment [8].
Our study demonstrated that there is no statistically significant difference in CCA IMT in patients who underwent CABG of three or more vessels, and those who underwent CABG of two or less vessels. Previously, a great number of studies demonstrated the relationship between carotid IMT and coronary stenosis severity, what was not statistically significant in our study [6, 9, 11, 12]. The association between IMT and CAD remains debatable [1]. The Atherosclerosis Risk in Communities study (ARIC) has shown that the risk of CAD gradually increases with higher values of IMT [3], but a recent analysis of the ARIC study showed that coronary heart disease (CHD) risk prediction could be improved by adding all carotid artery segments IMT (A-C IMT) or common carotid artery IMT (CCA-IMT) with plaque information to traditional risk factors [14].
However, a recently published meta-analysis of 11 population-based studies has shown that the ultrasound assessment of carotid plaque has a significantly higher accuracy for predicting future myocardial infarction or CAD events compared with carotid IMT assessment [8].
The meta-analysis of 27 diagnostic cohort studies (4.878 patients) also showed a higher, but nonsignificant, diagnostic accuracy of carotid plaque compared with CIMT for the detection of CAD [8]. In uremic patients IMT does not appear to add more information regarding risk stratification of CAD [5]. IMT increases with advancing CAD, patients with mean IMT over 1.15 mm have a 94% likelihood of having CAD, and the coexistence of CAD with severe stenosis of aortic arch arteries is relatively high and was found in 16.6% of patients with three vessel CAD [9]. IMT incorporating data from common and internal carotid artery, carotid bifurcation and femoral artery are well correlated with the extent of coronary atherosclerosis, much better than individual IMT [11]. A high-risk IMT score predicted an extended coronary artery disease although a low or medium risk IMT score cannot exclude the possibility of multivessel disease [11].
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The meta-analysis of 27 diagnostic cohort studies (4.878 patients) also showed a higher, but nonsignificant, diagnostic accuracy of
carotid
plaque
compared with CIMT for the detection of CAD [8].
Our study demonstrated that there is no statistically significant difference in CCA IMT in patients who underwent CABG of three or more vessels, and those who underwent CABG of two or less vessels. Previously, a great number of studies demonstrated the relationship between carotid IMT and coronary stenosis severity, what was not statistically significant in our study [6, 9, 11, 12]. The association between IMT and CAD remains debatable [1]. The Atherosclerosis Risk in Communities study (ARIC) has shown that the risk of CAD gradually increases with higher values of IMT [3], but a recent analysis of the ARIC study showed that coronary heart disease (CHD) risk prediction could be improved by adding all carotid artery segments IMT (A-C IMT) or common carotid artery IMT (CCA-IMT) with plaque information to traditional risk factors [14]. However, a recently published meta-analysis of 11 population-based studies has shown that the ultrasound assessment of carotid plaque has a significantly higher accuracy for predicting future myocardial infarction or CAD events compared with carotid IMT assessment [8].
The meta-analysis of 27 diagnostic cohort studies (4.878 patients) also showed a higher, but nonsignificant, diagnostic accuracy of carotid plaque compared with CIMT for the detection of CAD [8].
In uremic patients IMT does not appear to add more information regarding risk stratification of CAD [5]. IMT increases with advancing CAD, patients with mean IMT over 1.15 mm have a 94% likelihood of having CAD, and the coexistence of CAD with severe stenosis of aortic arch arteries is relatively high and was found in 16.6% of patients with three vessel CAD [9]. IMT incorporating data from common and internal carotid artery, carotid bifurcation and femoral artery are well correlated with the extent of coronary atherosclerosis, much better than individual IMT [11]. A high-risk IMT score predicted an extended coronary artery disease although a low or medium risk IMT score cannot exclude the possibility of multivessel disease [11]. The current guidelines prefer CABG surgery in patients with diabetes and multivessel diseases.
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Carotid
plaque
, compared with
carotid
intima-media thickness, more accurately predicts coronary artery disease events: A meta-analysis.
Inaba Y, Chen JA, Bergmann SR.
Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: A meta-analysis.
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Carotid
plaque
pathology: thrombosis, ulceration, and stroke pathogenesis.
Fisher M, Paganini-Hill A, Martin A.
Carotid plaque pathology: thrombosis, ulceration, and stroke pathogenesis.
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11.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 14, 2018, No. 2
,
,
,
Carotid
plaque
may be a source of cerebral embolization as well, leading to embolic stroke.
Carotid stenosis may result in stroke by hemodynamic and/or embolic mechanisms [4]. A hemodynamic stroke caused by carotid stenosis is due to decreased perfusion pressure that is associated with compensatory dilation of cerebral microvessels. Decrease of perfusion pressure depends on the severity and length of carotid stenosis and the collateral circulation [1].
Carotid plaque may be a source of cerebral embolization as well, leading to embolic stroke.
Patients with unstable carotid plaque with high-risk of artery-toartery embolization can be selected by detection of microembolic signals [9, 11].
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Patients with unstable
carotid
plaque
with high-risk of artery-toartery embolization can be selected by detection of microembolic signals [9, 11].
Carotid stenosis may result in stroke by hemodynamic and/or embolic mechanisms [4]. A hemodynamic stroke caused by carotid stenosis is due to decreased perfusion pressure that is associated with compensatory dilation of cerebral microvessels. Decrease of perfusion pressure depends on the severity and length of carotid stenosis and the collateral circulation [1]. Carotid plaque may be a source of cerebral embolization as well, leading to embolic stroke.
Patients with unstable carotid plaque with high-risk of artery-toartery embolization can be selected by detection of microembolic signals [9, 11].
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Unilateral presence of microembolic signals in the middle cerebral artery (MCA) indicates artery-to-artery embolisms from unstable
carotid
plaque
.
Transcranial Doppler (TCD) is an easy, noninvasive, relatively cheap tool to investigate the reactivity of cerebral microvessels to vasodilative stimuli (cerebral vasoreactivity), and thus it is able to assess the compensatory vasodilation of cerebral arterioles [1, 3, 10, 20, 23]. It should be mentioned that flow velocity is monitored in the main intracranial arteries (mostly in the middle cerebral artery), while the vasodilative stimuli change the diameter of the small resistance vessels (Fig. 1). TCD is an excellent method to detect cerebral microemboli as well [9, 11].
Unilateral presence of microembolic signals in the middle cerebral artery (MCA) indicates artery-to-artery embolisms from unstable carotid plaque.
In addition, carotid ultrasound may also help differentiate high-risk and low-risk plaques in the internal carotid artery. Carotid plaques with irregular surface, intraplaque haemorrhage, decreased echogenicity and without echogenic cap belong to high-risk plaques. Rapid progression of carotid stenosis was also shown to be associated with an increased risk of ischemic stroke [16].
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Carotid
plaque
echolusency detected by Color Coded Doppler ultrasonography (CCDS) and intraplaque neovascularization (IPNV) by contrast enhanced ultrasound (CEUS) have been recognized as potential markers of
plaque
vulnerability.
Carotid plaque echolusency detected by Color Coded Doppler ultrasonography (CCDS) and intraplaque neovascularization (IPNV) by contrast enhanced ultrasound (CEUS) have been recognized as potential markers of plaque vulnerability.
Application of Superb Microvascularisation Imaging (SMI) created by Toshiba to overcome the limitations of conventional Doppler technique for the visualisation of microvessels with low velocity flow has been effectively used in recent years. The most important contributors to unstable atherosclerotic lesions such as plaque angiogenesis and intraplaque haemorrhage, plaques echolusency, spotty micro-calcifications and higher internal carotid artery strain are analysed in the lecture according to different modalities of imaging. The effectiveness and limitations of different ultrasound techniques as CCDS, elastography, CEUS and SMI for the evaluation of plaques surface, echogenicity, IPNV and arterial wall stiffness are compared to Positron Emission Tomography, Computed Tomography and Magnetic Resonance Imaging.
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