超声造影显像评价颈动脉斑块内新生血管与心血管事件的关系邓又斌课件

Carotid Plaque Neovascularization and Cardiovascular Events Assessed by Contrast-Enhanced Ultrasound Imaging 超声造影显像评价颈动脉斑块内新生血管与 心血管事件的关系,You-Bin Deng, MD, 邓又斌 Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China 武汉同济医院,Plaque rupture is the most common type of plaque complication, accounting for 70% of fatal acute myocardial infarctions and/or sudden coronary deaths. Naghavi M et al. Circulation 2003;108:1664,Naghavi M et al. Circulation 2003;108:1664,Naghavi M et al. Circulation 2003;108:1664,Unadjusted Incidence of Myocardial Infarction or Stroke According to Quintile of Carotid-Artery IntimaMedia Thickness. Oleary DH et al. N Engl J Med 1999;340:14,Prevalence of normal carotid arteries and simple and complex carotid plaques in unstable (UA) and stable (SA) angina patients. Lambardo A et al. Circulation 2004; 109-3158,Honda O et al. JACC 2004;43:1177,Honda O et al. JACC 2004;43:1177,Naghavi M et al. Circulation 2003;108:1664,Mechanisms of vessel wall neovascularization in atherosclerosis Doyle B et al. JACC 2007; 49:2073,Possible roles for microvessels in disease progression include the supply of cellular and soluble lesion components, enhancement of intraplaque gas exchange, and delivery of metabolic substrates to the plaque core. Doyle B et al. JACC 2007; 49:2073,Neovascularization in Stable and Unstable Coronary Plaques,Kolodgie FD et al. JACC 2007;49:2093,Plaque neovascularization and clinical symptoms,Fleiner M et al. Circulation 2004;110:2843,Number of microvessels identified from plaques of symptomatic and asymptomatic patients.,McCarthy MJ et al. J Vasc Surg 1999;30:261,Characteristics of contrast agent (SonoVue),Vessel Density at Histology According to Plaque Contrast-Agent Enhancement,Coli S et al. JACC 2008;52:223,No 2984, M, 71 yrs,Standard and contrast-enhanced carotid ultrasound images in a 78-year-old man who experienced serial transient ischemic attack 2 days before examination.,Xiong L et al: Radiology 2009;251:583,Xiong L et al: Radiology 2009;251:583,Xiong L et al: Radiology 2009;251:583,Vulnerable patients have vulnerable plaques. Plaque rupture is the most common type of plaque complication, accounting for 70% of fatal acute myocardial infarctions and/or sudden coronary deaths. Plaque instability is not merely a local vascular incident but rather that plaque instability exists simultaneously at multiple sites in the systemic vascular bed, inclucing carotid artery. Plaque neovascularization is the remarkably consistent feature of vulnerable plaque in cardio-cerebrovascular patients.,Contrast-enhanced carotid ultrasound imaging is promising and may serve to detect the neovascularization within the atherosclerotic plaque in vivo. Carotid plaque contrast-agent enhancement with sonographic agent correlates with histological density of neovessels within the carotid plaque. Symptomatic patients had more intense contrast agent enhancement in the plaque than asymptomatic patients, suggesting that contrast-enhanced carotid US may be used for plaque risk stratification. The association between the carotid plaque enhancement with contrast agent microbubbles and the acute coronary syndrome is not fully understood.,Study Population,Acute coronary syndrome: 35 (man: 27; woman: 8. Mean age: 639 years Stable angina: 32 (man: 23; woman: 9. Mean age: 608 years. Carotid plaque thickness: larger than 2.0 mm.,研究方法,GE Log9超声诊断仪 9L探头：频率为6MHz 机械指数：0.13,67例患者,快速静脉注射SonoVue 1.5 ml,实时观察颈动脉腔及斑块内造影剂显影情况,Grade 1: no enhancement within the plaque or enhancement confined to plaque adventitial side and/or shoulder Grade 2: enhancement reaching plaque core/or extensive contrast agent enhancement throughout the plaque.,Grading of Contrast-Agent Enhancement by Visual Interpretation,Grading of Contrast-Agent Enhancement by Quantitative Analysis,Enhanced intensity in the plaque Ratio of the enhanced intensity in the plaque to that in the carotid artery lumen,Carotid plaque features in acute coronary syndrome and stable angina,*,*p0.0001 vs. SA,28/35,22/32,2/35,3/32,1/35,2/32,4/35,2/32,（80%）,（68%）,*,23/35,17/32,（66%）,（53%）,Contrast enhancement of carotid plaque in acute coronary syndrome and stable angina,*p0.037 vs. SA,23/35,（66%）,17/32,（53%）,*,11.823.59,7.494.62,dB,Contrast enhanced intensity in carotid plaque in acute coronary syndrome and stable angina,*p0.001 vs. SA,*,0.510.15,0.330.22,Ratio of contrast enhanced intensity in carotid plaque to that in carotid lumen in acute coronary syndrome and stable angina,*p0.001 vs. SA,Receiver Operating Characteristic Curve Analysis,The sensitivity and specificity for enhanced intensity in the plaque (cutoff value: 9.95 dB) were 74% and 60%, respectively and those for ratio of enhanced intensity in the plaque to that in the carotid artery lumen (cutoff value: 0.45) were 86% and 67%, respectively.,In conclusion, contrast-enhanced carotid ultrasound imaging provided us a way for the direct visualization of neovascularization within the plaque. Patients w