Contrast-Enhanced Ultrasound Predicts Stroke Risk in Carotid Plaque

Contrast-enhanced ultrasound (CEUS) holds significant value in assessing carotid plaque vulnerability and predicting stroke risk. The study involved 91 patients with carotid stenosis who underwent carotid endarterectomy (CEA). Preoperative assessments included CEUS and high-resolution magnetic resonance imaging (HR-MRI), with plaque samples collected post-surgery for pathological analysis. CEUS provided detailed insights into plaque morphology, categorizing plaques based on contrast agent diffusion direction and neovascularization. HR-MRI and pathological assessments further identified plaque composition and vulnerability.

Among the subjects, those with a history of symptomatic stroke events showed a significant association with fibrous cap rupture, contrast agent diffusion within the plaque, and neovascularization grades. CEUS grade 3 emerged as an independent predictor of symptomatic stroke events. Comparative analysis between CEUS and HR-MRI revealed slightly superior diagnostic performance for CEUS in identifying vulnerable plaques. Plaques with inside-out contrast agent diffusion exhibited a higher incidence of fibrous cap rupture and intraplaque hemorrhage.

The study highlighted the correlation between CEUS grading and microvessel parameters, showing a positive relationship with microvessel density ratio and intraplaque hemorrhage. This in-depth analysis emphasized the potential of CEUS as a non-invasive tool for assessing carotid plaque instability and identifying individuals at elevated risk for stroke. The study’s methodology advances plaque vulnerability assessment and suggests the need for further research to validate CEUS’s clinical applicability in stroke risk prediction.